Healthcare Provider Details

I. General information

NPI: 1346039419
Provider Name (Legal Business Name): NIKKI WHOLE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21214 MALIBU COLONY
SAN ANTONIO TX
78259-2009
US

IV. Provider business mailing address

21214 MALIBU COLONY
SAN ANTONIO TX
78259-2009
US

V. Phone/Fax

Practice location:
  • Phone: 210-960-2653
  • Fax: 210-492-0747
Mailing address:
  • Phone: 210-960-2653
  • Fax: 210-492-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: NICOLE BONDURIS WALDEN
Title or Position: CEO
Credential: CNS, LDN, LMT
Phone: 940-368-2328