Healthcare Provider Details

I. General information

NPI: 1366273369
Provider Name (Legal Business Name): NICOLE MARIE WARRICK PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 10/25/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 CROASDAILE DRIVE SUITE 400
DURHAM NC
27705
US

IV. Provider business mailing address

3202 SKYBROOK LN
DURHAM NC
27703-5983
US

V. Phone/Fax

Practice location:
  • Phone: 919-384-9682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: