Provider Demographics
NPI:1679222681
Name:DAVIDSON, NICOLE ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LAZY G RD
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8852
Mailing Address - Country:US
Mailing Address - Phone:307-761-4848
Mailing Address - Fax:
Practice Address - Street 1:14 LAZY G RD
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8852
Practice Address - Country:US
Practice Address - Phone:307-761-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-2340175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath