Provider Demographics
NPI:1174682462
Name:CHUN, NICOLETTE MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:NICOLETTE
Middle Name:MARIE
Last Name:CHUN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:NICKI
Other - Middle Name:MARIE
Other - Last Name:CHUN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:875 BLAKE WILBUR DR.
Mailing Address - Street 2:RM. 2320
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5822
Mailing Address - Country:US
Mailing Address - Phone:650-724-4363
Mailing Address - Fax:650-498-5150
Practice Address - Street 1:975 BLAKE WILBUR DR.
Practice Address - Street 2:RM. 2320
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5822
Practice Address - Country:US
Practice Address - Phone:650-724-4363
Practice Address - Fax:650-498-5150
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS