Provider Demographics
NPI:1295490050
Name:AUBERT, NICHOLE J
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:J
Last Name:AUBERT
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 1:5465 MILLS CIVIC PKWY UNIT 430
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5327
Mailing Address - Country:US
Mailing Address - Phone:515-441-1545
Mailing Address - Fax:
Practice Address - Street 1:5465 MILLS CIVIC PKWY UNIT 430
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5327
Practice Address - Country:US
Practice Address - Phone:515-441-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA242CC7893347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle