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General NPI Number Information
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NPI Number | 1922931922
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Entity Type | Organization
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Legal Business Name | NICOLE BEASLEY, PHD
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Dates
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Enumeration Date | 06/08/2026
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Last Update Date | 06/08/2026
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Provider Practice Location Address
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Address Line | 1727 YORKTOWN DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-3035
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Country | US
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Telephone | 415-336-5343
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Fax |
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Provider Business Mailing Address
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Address Line | 1727 YORKTOWN DR
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-3035
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Country | US
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Telephone | 415-336-5343
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Fax |
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Authorized Official
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Title or Position | COACH
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Name | NICOLE WORDLAW
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Credential | PHD
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Telephone | 415-336-5343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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