Provider Demographics
NPI:1083806137
Name:ANDERSON, NICOLE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:E
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6984 W AVONDALE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-1408
Mailing Address - Country:US
Mailing Address - Phone:520-250-1833
Mailing Address - Fax:
Practice Address - Street 1:11279 W GRIER RD
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9609
Practice Address - Country:US
Practice Address - Phone:520-682-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool