Provider Demographics
NPI:1962039479
Name:LEHMAN, NICOLE HELEY
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:HELEY
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 NW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-1053
Mailing Address - Country:US
Mailing Address - Phone:515-291-5656
Mailing Address - Fax:
Practice Address - Street 1:3190 NW 142ND AVE
Practice Address - Street 2:
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-1053
Practice Address - Country:US
Practice Address - Phone:515-291-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IA105339363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program