Provider Demographics
NPI:1336534627
Name:NIRVA, NICOLE ANN
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:NIRVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ANN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7933 FALL CREEK RD.
Mailing Address - Street 2:APT. 205
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:313-539-7501
Mailing Address - Fax:
Practice Address - Street 1:5729 SONOMA DR
Practice Address - Street 2:SUITE F
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7782
Practice Address - Country:US
Practice Address - Phone:925-462-2281
Practice Address - Fax:925-462-0439
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst