Healthcare Provider Details

I. General information

NPI: 1598982886
Provider Name (Legal Business Name): NICOLA LOUISE DUCHARME N.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLA LOUISE MCFADZEAN ND

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 FORT STOCKTON DR SUITE 213
SAN DIEGO CA
92103-1881
US

IV. Provider business mailing address

928 FORT STOCKTON DR SUITE 213
SAN DIEGO CA
92103-1881
US

V. Phone/Fax

Practice location:
  • Phone: 619-546-4065
  • Fax: 619-270-2582
Mailing address:
  • Phone: 619-546-4065
  • Fax: 619-270-2582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND27
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: