Healthcare Provider Details

I. General information

NPI: 1720110364
Provider Name (Legal Business Name): NICOLE MICHELLE NOURMAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8907 WILSHIRE BLVD SUITE 250
BEVERLY HILLS CA
90211-1937
US

IV. Provider business mailing address

8907 WILSHIRE BLVD SUITE 250
BEVERLY HILLS CA
90211-1937
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-8687
  • Fax: 310-859-9131
Mailing address:
  • Phone: 310-247-8687
  • Fax: 310-859-9131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA89815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: