Healthcare Provider Details

I. General information

NPI: 1043964356
Provider Name (Legal Business Name): NICOLE HELENE ARMSTRONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2022
Last Update Date: 02/06/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

1100 PACIFIC MARINA
ALAMEDA CA
94501-1124
US

V. Phone/Fax

Practice location:
  • Phone: 800-607-6377
  • Fax:
Mailing address:
  • Phone: 619-600-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: