Healthcare Provider Details

I. General information

NPI: 1942130331
Provider Name (Legal Business Name): NICOLE DESIRAE STEARNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10345 PROFESSIONAL CIR STE 125
RENO NV
89521-3100
US

IV. Provider business mailing address

350 HARBOUR COVE DR APT 217
SPARKS NV
89434-7867
US

V. Phone/Fax

Practice location:
  • Phone: 775-348-7300
  • Fax:
Mailing address:
  • Phone: 209-993-9384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: