Provider Demographics
NPI:1710230354
Name:LEAN, NICOLE ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:ANN
Last Name:LEAN
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:PO BOX 422
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-0422
Mailing Address - Country:US
Mailing Address - Phone:818-850-5326
Mailing Address - Fax:
Practice Address - Street 1:4433 E VILLAGE RD
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1505
Practice Address - Country:US
Practice Address - Phone:818-850-5326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-549175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath