Provider Demographics
NPI:1437482106
Name:FRANKS, NICOLE MARIE
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MARIE
Last Name:FRANKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICKY FRANKS
Other - Middle Name:MARIE
Other - Last Name:FRANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2623 SE ANKENY ST
Mailing Address - Street 2:APARTMENT 305
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1764
Mailing Address - Country:US
Mailing Address - Phone:203-470-4960
Mailing Address - Fax:
Practice Address - Street 1:2623 SE ANKENY STREET
Practice Address - Street 2:APT 305
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:203-470-4960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTXGN0879M49462OtherANTHEM