Healthcare Provider Details

I. General information

NPI: 1679190755
Provider Name (Legal Business Name): NICOLE CATHERINE WEIDOW DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE CATHERINE MICHEL DO

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9827 N 95TH ST STE 105
SCOTTSDALE AZ
85258-4591
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-8488
  • Fax: 480-860-8498
Mailing address:
  • Phone: 866-401-3057
  • Fax: 318-868-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO.2671
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number012355
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: