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NPI Code Detail

MEDICARE: NICOLE CAMILLE ARCHULETA

MEDICARE: NICOLE CAMILLE ARCHULETA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor0178081NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720580681
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE CAMILLE ARCHULETA
Provider Business Mailing Address
First Line : 1227 N RAILROAD AVE STE C
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3159
Country : US
Telephone Number : 505-747-8187
Fax Number :
Provider Business Practice Location Address
First Line : 1227 N RAILROAD AVE STE C
Second Line :
City : ESPANOLA
State : NM
Zip : 87532-3159
Country : US
Telephone Number : 505-747-8187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2018
Last Update Date : 03/06/2018

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1629570585 — SCARLETTE ALLYN WATERMAN BA, LSAA
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Practice Location Address:
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Directions to “ NICOLE CAMILLE ARCHULETA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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