MEDICARE: NICOLE KREPS

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	674443	CA
2	163WL0100X	Lactation Consultant (Registered Nurse)	L-110576	CA

General Provider Information

NPI Number	:	1770017147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE KREPS

Provider Business Mailing Address
First Line	:	2461 COWLEY WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1133
Country	:	US
Telephone Number	:	619-208-1821
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 COWLEY WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1133
Country	:	US
Telephone Number	:	619-208-1821
Fax Number	:

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	04/12/2017

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Directions to “ NICOLE KREPS ” Practice Location

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