Healthcare Provider Details

I. General information

NPI: 1063523306
Provider Name (Legal Business Name): NICHOLE MARIA HIGHTOWER M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD MCCLELALN PARK VAOPC (AUDIOLOGY 126)
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

5342 DUDLEY BLVD MCCLELALN PARK VAOPC (AUDIOLOGY 126)
MCCLELLAN CA
95652-1012
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7470
  • Fax:
Mailing address:
  • Phone: 916-561-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU2346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: