MEDICARE: NICOLE SUGAMELE

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	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1750061719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SUGAMELE

Provider Business Mailing Address
First Line	:	3220 THISTLE DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-5514
Country	:	US
Telephone Number	:	928-486-9983
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 STARLINE DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-5400
Country	:	US
Telephone Number	:	928-505-1490
Fax Number	:

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

Provider Enumeration Date	:	07/24/2023
Last Update Date	:	07/24/2023

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Directions to “ NICOLE SUGAMELE ” Practice Location

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