Provider Demographics
NPI:1285078196
Name:MYERS, NICOLE MARIE (ARNP (FNP-BC))
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:MARIE
Last Name:MYERS
Suffix:
Gender:F
Credentials:ARNP (FNP-BC)
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MARIE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:855 A AVENUE NE
Mailing Address - Street 2:PO BOX 3080
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3080
Mailing Address - Country:US
Mailing Address - Phone:319-391-5501
Mailing Address - Fax:319-743-2610
Practice Address - Street 1:855 A AVENUE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402
Practice Address - Country:US
Practice Address - Phone:319-391-5501
Practice Address - Fax:319-743-2610
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA122399363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0297192Medicaid
IA0297192Medicaid