Provider Demographics
NPI:1174814255
Name:ATWELL, NICOLE LYNN (MED)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:ATWELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BACHELOR BUTTON ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6077
Mailing Address - Country:US
Mailing Address - Phone:702-290-1811
Mailing Address - Fax:
Practice Address - Street 1:516 BACHELOR BUTTON ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-6077
Practice Address - Country:US
Practice Address - Phone:702-290-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0000077417171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator