Healthcare Provider Details

I. General information

NPI: 1043669351
Provider Name (Legal Business Name): NICOLE CESAR LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 EASTERN AVE
DAVENPORT IA
52803-2012
US

IV. Provider business mailing address

132 W MAYNE ST
BLUE GRASS IA
52726-9773
US

V. Phone/Fax

Practice location:
  • Phone: 563-445-0557
  • Fax:
Mailing address:
  • Phone: 563-210-0666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number081706
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier081706
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBUREAU OF PROFESSIONAL LICENSURE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: