Provider Demographics
NPI:1578895132
Name:RICHARDSON, NICOLE ARVETTE
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:ARVETTE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W WOODCROFT PKWY APT 56A
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8079
Mailing Address - Country:US
Mailing Address - Phone:919-491-7410
Mailing Address - Fax:
Practice Address - Street 1:200 W WOODCROFT PKWY APT 56A
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-8079
Practice Address - Country:US
Practice Address - Phone:919-491-7410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion