Provider Demographics
NPI:1073883898
Name:DENHERDER, NICOLE DENISE
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:DENISE
Last Name:DENHERDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2154
Mailing Address - Country:US
Mailing Address - Phone:775-544-6826
Mailing Address - Fax:
Practice Address - Street 1:421 W PLUMB LN STE A-5
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3766
Practice Address - Country:US
Practice Address - Phone:775-338-3786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker