Provider Demographics
NPI:1851808513
Name:PACIA, NICHELLE BANAG (ND)
Entity Type:Individual
Prefix:DR
First Name:NICHELLE
Middle Name:BANAG
Last Name:PACIA
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 1:12911 BONNIE LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4563
Mailing Address - Country:US
Mailing Address - Phone:832-293-0703
Mailing Address - Fax:
Practice Address - Street 1:26440 FM 1093 RD STE 350
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7200
Practice Address - Country:US
Practice Address - Phone:832-987-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-03
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0002175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty