Provider Demographics
NPI:1588815179
Name:TRUDEAU, NICOLLE BETH
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:BETH
Last Name:TRUDEAU
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 1:2044 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3832
Mailing Address - Country:US
Mailing Address - Phone:520-668-1623
Mailing Address - Fax:
Practice Address - Street 1:2044 E 32ND ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-3832
Practice Address - Country:US
Practice Address - Phone:520-668-1623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider