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General NPI Number Information
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NPI Number | 1548997026
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Entity Type | Individual
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Provider Name | NICOLE DUENKE
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 08/04/2022
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Provider Practice Location Address
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Address Line | 2206 EXECUTIVE DR STE A
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City | HAMPTON
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State | VA
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Zip | 23666-2583
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Country | US
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Telephone | 757-664-9778
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 HUNNINGDON WOODS BLVD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8290
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Country | US
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Telephone | 757-240-7255
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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