Provider Demographics
NPI:1043522766
Name:AUSDEMORE, NICOLE R (AZCCE,AZCD,CD(DONA))
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:AUSDEMORE
Suffix:
Gender:F
Credentials:AZCCE,AZCD,CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 W MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-7427
Mailing Address - Country:US
Mailing Address - Phone:480-671-4534
Mailing Address - Fax:
Practice Address - Street 1:1640 W MONTE AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-7427
Practice Address - Country:US
Practice Address - Phone:480-671-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula