Provider Demographics
NPI:1407169857
Name:BELLOWS, NIKOLE RENEE
Entity Type:Individual
Prefix:
First Name:NIKOLE
Middle Name:RENEE
Last Name:BELLOWS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NIKOLE
Other - Middle Name:RENEE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1213 W HANKS TRL
Mailing Address - Street 2:
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-7601
Mailing Address - Country:US
Mailing Address - Phone:508-254-5322
Mailing Address - Fax:580-254-5335
Practice Address - Street 1:1213 W HANKS TRL
Practice Address - Street 2:
Practice Address - City:WOODWARD
Practice Address - State:OK
Practice Address - Zip Code:73801-7601
Practice Address - Country:US
Practice Address - Phone:508-254-5322
Practice Address - Fax:580-254-5335
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker