=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801171871
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLE HELEN GERARD N.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2011
-----------------------------------------------------
Last Update Date | 10/20/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4657 S LAKESHORE DR SUITE 1
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85282-7170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-284-8155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 809 W GROVE PKWY APT 3097
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-8440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-953-5783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 11-1261
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------