Healthcare Provider Details

I. General information

NPI: 1205761632
Provider Name (Legal Business Name): NICOLE C SHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 W CAMINO DE MANANA
TUCSON AZ
85742-8835
US

IV. Provider business mailing address

5051 W CAMINO DE MANANA
TUCSON AZ
85742-8835
US

V. Phone/Fax

Practice location:
  • Phone: 303-968-7838
  • Fax:
Mailing address:
  • Phone: 303-968-7838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: