Provider Demographics
NPI:1578315487
Name:ARTISE, NICOLE (CMA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ARTISE
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-6935
Mailing Address - Country:US
Mailing Address - Phone:757-572-0932
Mailing Address - Fax:
Practice Address - Street 1:1217 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-6935
Practice Address - Country:US
Practice Address - Phone:757-572-0932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAY6X9Y6Z9374700000X, 246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No374700000XNursing Service Related ProvidersTechnician