Provider Demographics
NPI:1013178086
Name:NICOLE R. KERR, LLC
Entity Type:Organization
Organization Name:NICOLE R. KERR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:315-405-5925
Mailing Address - Street 1:660 MIX AVE APT 6L
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2384
Mailing Address - Country:US
Mailing Address - Phone:315-405-5925
Mailing Address - Fax:
Practice Address - Street 1:867 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1728
Practice Address - Country:US
Practice Address - Phone:203-387-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000389175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty