Healthcare Provider Details

I. General information

NPI: 1881010833
Provider Name (Legal Business Name): NICHOLE C VETTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BREWSTER BLVD
CAMP LEJEUNE NC
28547-2575
US

IV. Provider business mailing address

PO BOX 388
PLUMMER ID
83851-0388
US

V. Phone/Fax

Practice location:
  • Phone: 910-450-4300
  • Fax:
Mailing address:
  • Phone: 208-686-1931
  • Fax: 208-686-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1417A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: