=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497583934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE TURNER PPS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2024
-----------------------------------------------------
Last Update Date | 07/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6250 SCOTTS CREEK DR
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95219-7244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-953-9302
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 103 NOBEL AVE
-----------------------------------------------------
City | LODI
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95242-9734
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-996-1398
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YS0200X
-----------------------------------------------------
Taxonomy Name | School Counselor
-----------------------------------------------------
License Number | 230029297
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------