Healthcare Provider Details

I. General information

NPI: 1659635464
Provider Name (Legal Business Name): NICOLE E THURMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE E MCNICOL

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

IV. Provider business mailing address

1101 N CENTRAL AVE STE 204
PHOENIX AZ
85004-1844
US

V. Phone/Fax

Practice location:
  • Phone: 602-344-6550
  • Fax:
Mailing address:
  • Phone: 602-344-6550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN144954
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4534
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: