Healthcare Provider Details

I. General information

NPI: 1992942452
Provider Name (Legal Business Name): NICOLE BARNARD D.O.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 JUAN TABO BLVD NE STE 117
ALBUQUERQUE NM
87112-1885
US

IV. Provider business mailing address

2901 JUAN TABO BLVD NE STE 117
ALBUQUERQUE NM
87112-1885
US

V. Phone/Fax

Practice location:
  • Phone: 505-275-9602
  • Fax:
Mailing address:
  • Phone: 404-695-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: