Provider Demographics
NPI:1053642793
Name:CARDI, NICOLE L (AU D)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:CARDI
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-636-3300
Mailing Address - Fax:304-637-3435
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-637-3300
Practice Address - Fax:304-637-3435
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0261237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVCA4289081Medicare UPIN
WVP010844683Medicare UPIN
WVQ36666BMedicare PIN
KYP010844683Medicare UPIN