MEDICARE: NICOLE MACIEIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	908878	TX

General Provider Information

NPI Number	:	1134613227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MACIEIK

Provider Business Mailing Address
First Line	:	525 PAUL JONES PASS
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-2924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 PAUL JONES PASS
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78748-2924
Country	:	US
Telephone Number	:	504-329-4437
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	06/21/2018

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Directions to “ NICOLE MACIEIK ” Practice Location

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