Provider Demographics
NPI:1114515871
Name:MARCIONE, NICOLE (PHD, NBWHC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:MARCIONE
Suffix:
Gender:F
Credentials:PHD, NBWHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 CARNEGIE LN APT C
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3722
Mailing Address - Country:US
Mailing Address - Phone:424-247-3105
Mailing Address - Fax:
Practice Address - Street 1:2221 CARNEGIE LN APT C
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3722
Practice Address - Country:US
Practice Address - Phone:424-247-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator