Provider Demographics
NPI:1760770556
Name:ADAMS, NICOLE L (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:L
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:KESSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:4915 E BASELINE RD STE 121
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2969
Mailing Address - Country:US
Mailing Address - Phone:480-812-3668
Mailing Address - Fax:480-782-1290
Practice Address - Street 1:4915 E BASELINE RD STE 121
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2969
Practice Address - Country:US
Practice Address - Phone:480-812-3668
Practice Address - Fax:480-782-1290
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002357213ES0103X
AZ0771213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ856348Medicaid