Healthcare Provider Details

I. General information

NPI: 1982508743
Provider Name (Legal Business Name): NICOLE CORDEIRO LAC., DAHM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4524 SOUTHLAKE PKWY STE 27
HOOVER AL
35244-3272
US

IV. Provider business mailing address

3397 CEDARBROOK CIR
TRUSSVILLE AL
35173-2068
US

V. Phone/Fax

Practice location:
  • Phone: 954-482-3933
  • Fax:
Mailing address:
  • Phone: 954-482-3933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03177
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACUP.AC.70161316
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: