Provider Demographics
NPI:1508055625
Name:FLUNDER, NICHOLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:
Last Name:FLUNDER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:NUBIAN
Other - Middle Name:
Other - Last Name:FLUNDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:2863 BROADWAY
Mailing Address - Street 2:144
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5708
Mailing Address - Country:US
Mailing Address - Phone:510-459-8682
Mailing Address - Fax:415-492-8836
Practice Address - Street 1:2929 SUMMIT ST
Practice Address - Street 2:103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3423
Practice Address - Country:US
Practice Address - Phone:519-452-2929
Practice Address - Fax:415-492-8836
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist