Provider Demographics
NPI:1174023451
Name:NICHOLS, STEPHANIE (ND)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:URBANOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:1450 W GUADALUPE RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-3055
Mailing Address - Country:US
Mailing Address - Phone:480-531-2557
Mailing Address - Fax:
Practice Address - Street 1:1450 W GUADALUPE RD STE 115
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3055
Practice Address - Country:US
Practice Address - Phone:480-531-2557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS21-A0001-9171100000X
KS21-00048175F00000X
AZ19-1766175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist