Provider Demographics
NPI:1851342455
Name:MOORBECK, NICHOLE (AUD)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:MOORBECK
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2649
Mailing Address - Country:US
Mailing Address - Phone:702-252-3277
Mailing Address - Fax:702-385-3277
Practice Address - Street 1:2471 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2649
Practice Address - Country:US
Practice Address - Phone:702-252-3277
Practice Address - Fax:702-385-3277
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-181231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV101998Medicare ID - Type UnspecifiedPROVIDER MEDICARE ID