Healthcare Provider Details

I. General information

NPI: 1912257643
Provider Name (Legal Business Name): NICOLE G. SERS RT(R), BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 EUBANK SE
ALBUQUERQUE NM
87123
US

IV. Provider business mailing address

1515 EUBANK SE
ALBUQUERQUE NM
87123
US

V. Phone/Fax

Practice location:
  • Phone: 505-845-8055
  • Fax:
Mailing address:
  • Phone: 505-845-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: