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General NPI Number Information
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NPI Number | 1730126343
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Entity Type | Individual
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Provider Name | NICOLE PHOENIX ANDERSON PHD
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Gender | Female
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 6501 4TH ST NW F4
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City | LOS RANCHOS
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State | NM
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Zip | 87107-5800
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Country | US
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Telephone | 505-344-9641
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Fax | 505-344-2621
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Provider Business Mailing Address
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Address Line | PO BOX 66684
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City | ALBUQUERQUE
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State | NM
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Zip | 87193-6684
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Country | US
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Telephone | 505-344-9641
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Fax | 505-344-2621
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0976
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License Number State | NM
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