Provider Demographics
NPI:1134560915
Name:HUNT, NICOLE (CNM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HUNT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 VAN NUYS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-2231
Mailing Address - Country:US
Mailing Address - Phone:818-785-1890
Mailing Address - Fax:
Practice Address - Street 1:7232 VAN NUYS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-2231
Practice Address - Country:US
Practice Address - Phone:818-785-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2052367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife