Provider Demographics
NPI:1457856262
Name:MANDEVILLE, NICOLE JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:JEAN
Last Name:MANDEVILLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14331 46TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-7949
Mailing Address - Country:US
Mailing Address - Phone:425-418-5308
Mailing Address - Fax:
Practice Address - Street 1:14331 46TH AVE NW
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-7949
Practice Address - Country:US
Practice Address - Phone:425-418-5308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60638126163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine