Healthcare Provider Details

I. General information

NPI: 1720214513
Provider Name (Legal Business Name): NICOLE AMBER BERRY SCHICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2009
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 335TH PL SE UNIT 481
FALL CITY WA
98024-4020
US

IV. Provider business mailing address

4225 335TH PL SE UNIT 481
FALL CITY WA
98024-4020
US

V. Phone/Fax

Practice location:
  • Phone: 425-270-7001
  • Fax: 954-405-8854
Mailing address:
  • Phone: 425-270-7001
  • Fax: 954-405-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR-8685
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40115
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 60624082
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: