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NPI Code Detail

MEDICARE: NICOLE JEAN DE VERA

MEDICARE: NICOLE JEAN DE VERA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1164070397
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE JEAN DE VERA
Provider Business Mailing Address
First Line : 3253 19TH ST NW STE 1
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-6794
Country : US
Telephone Number : 507-218-2424
Fax Number :
Provider Business Practice Location Address
First Line : 3253 19TH ST NW STE 1
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-6794
Country : US
Telephone Number : 507-218-2424
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2019
Last Update Date : 08/30/2019

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Directions to “ NICOLE JEAN DE VERA ” Practice Location

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