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General NPI Number Information
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NPI Number | 1003493156
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Entity Type | Individual
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Provider Name | NICOLE SHUSTERMAN ND
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 04/06/2021
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Provider Practice Location Address
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Address Line | 17762 PRESTON RD # 101
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City | DALLAS
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State | TX
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Zip | 75252-5730
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Country | US
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Telephone | 469-323-8587
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Fax |
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Provider Business Mailing Address
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Address Line | 13378 NORTHERN DANCER WAY
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City | FRISCO
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State | TX
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Zip | 75035-0958
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Country | US
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Telephone | 469-323-8587
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 21-00068
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License Number State | KS
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