Healthcare Provider Details

I. General information

NPI: 1235074139
Provider Name (Legal Business Name): NICOLE STOREY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENNSYLVANIA ST NE STE B
ALBUQUERQUE NM
87110-7404
US

IV. Provider business mailing address

1110 PENNSYLVANIA ST NE STE B
ALBUQUERQUE NM
87110-7404
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-0753
  • Fax:
Mailing address:
  • Phone: 505-265-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: