Provider Demographics
NPI:1659677920
Name:NANCE, NICOLE ANN (LISW)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ANN
Last Name:NANCE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1327 WALSH STREE SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124
Mailing Address - Country:US
Mailing Address - Phone:505-264-9572
Mailing Address - Fax:
Practice Address - Street 1:1327 WALSH ST SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2985
Practice Address - Country:US
Practice Address - Phone:505-264-9572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-074191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical