Healthcare Provider Details

I. General information

NPI: 1871325928
Provider Name (Legal Business Name): NICHOLE ALFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W HAPPY VALLEY RD STE 4
PHOENIX AZ
85085-3709
US

IV. Provider business mailing address

7539 W CHARTER OAK RD
PEORIA AZ
85381-5321
US

V. Phone/Fax

Practice location:
  • Phone: 602-489-4958
  • Fax: 877-387-7848
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number312979
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: