Provider Demographics
NPI:1053490276
Name:WESTPHAL, NICOLETTE (DOM)
Entity Type:Individual
Prefix:
First Name:NICOLETTE
Middle Name:
Last Name:WESTPHAL
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 SPAIN RD NE STE E
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1895
Mailing Address - Country:US
Mailing Address - Phone:505-271-1886
Mailing Address - Fax:
Practice Address - Street 1:11000 SPAIN RD NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1895
Practice Address - Country:US
Practice Address - Phone:505-271-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM287RX1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM01R50MOtherBLUECROSS BLUE SHIELD ID