Healthcare Provider Details

I. General information

NPI: 1790873230
Provider Name (Legal Business Name): NICOLE MARIE HOULE NP-C, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEDICAL CENTER DR
MURRIETA CA
92562-5965
US

IV. Provider business mailing address

23775 BROOKSIDE CT
MURRIETA CA
92562-2237
US

V. Phone/Fax

Practice location:
  • Phone: 951-816-0400
  • Fax: 951-461-7108
Mailing address:
  • Phone: 951-816-0400
  • Fax: 951-461-7108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN494223
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19547
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: