Healthcare Provider Details

I. General information

NPI: 1861861007
Provider Name (Legal Business Name): NICOLE CHARLOTTE SALVATORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE CHARLOTTE ALLSWORTH

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 03/17/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 W FRYE RD
CHANDLER AZ
85224-6282
US

IV. Provider business mailing address

1955 W FRYE RD
CHANDLER AZ
85224-6282
US

V. Phone/Fax

Practice location:
  • Phone: 480-728-3000
  • Fax:
Mailing address:
  • Phone: 480-728-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6143
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number6143
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: