Healthcare Provider Details

I. General information

NPI: 1417947797
Provider Name (Legal Business Name): NICOLE H. ARMITAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MEDICAL GROUP 4881 SUGAR MAPLE DR., BLDG 830
WRIGHT-PATTERSON AFB OH
45433-5529
US

IV. Provider business mailing address

101 BODIN CIRCLE 60 MDG/SGSE
TRAVIS AFB CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 937-938-3101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR034438
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP81701
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: