Provider Demographics
NPI:1700855509
Name:KAISER, NICHOLE F (CPNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:F
Last Name:KAISER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4562 S WILDFLOWER PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-4862
Mailing Address - Country:US
Mailing Address - Phone:480-361-9600
Mailing Address - Fax:
Practice Address - Street 1:595 N DOBSON RD
Practice Address - Street 2:STE A18
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4226
Practice Address - Country:US
Practice Address - Phone:480-821-1400
Practice Address - Fax:480-821-2210
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN111290363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ967870Medicaid