Provider Demographics
NPI:1407017106
Name:NEDELLA, NICOLE E (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:NEDELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:E
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12330 W LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5523
Mailing Address - Country:US
Mailing Address - Phone:602-334-6588
Mailing Address - Fax:
Practice Address - Street 1:4700 S SYRACUSE ST STE 900
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80237-2741
Practice Address - Country:US
Practice Address - Phone:888-293-2939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR1019390200000X
AZ005318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program