MEDICARE: DR. NICOLE HELEN GERARD N.D.

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	175F00000X	Naturopath	11-1261	AZ

General Provider Information

NPI Number	:	1801171871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE HELEN GERARD N.D.

Provider Business Mailing Address
First Line	:	809 W GROVE PKWY
Second Line	:	APT 3097
City	:	TEMPE
State	:	AZ
Zip	:	85283-8440
Country	:	US
Telephone Number	:	815-953-5783
Fax Number	:

Provider Business Practice Location Address
First Line	:	4657 S LAKESHORE DR
Second Line	:	SUITE 1
City	:	TEMPE
State	:	AZ
Zip	:	85282-7170
Country	:	US
Telephone Number	:	480-284-8155
Fax Number	:

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	10/20/2011

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