Provider Demographics
NPI:1275816431
Name:NICOLAI, KATHERINE MARIE
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:MARIE
Last Name:NICOLAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SANTA MONICA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1538
Mailing Address - Country:US
Mailing Address - Phone:415-307-3809
Mailing Address - Fax:
Practice Address - Street 1:94 SANTA MONICA WAY
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1538
Practice Address - Country:US
Practice Address - Phone:415-307-3809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program