Healthcare Provider Details

I. General information

NPI: 1669670634
Provider Name (Legal Business Name): NICOLE ANNE ABDY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AZ HEALTH SCIENCE CENTER 3335 1501 N. CAMPBELL AVENUE
TUCSON AZ
85724-0001
US

IV. Provider business mailing address

1501 N CAMPBELL AVE PO BOX 245073
TUCSON AZ
85724-0001
US

V. Phone/Fax

Practice location:
  • Phone: 520-626-7944
  • Fax:
Mailing address:
  • Phone: 520-237-9853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43329
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number81932
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: