Provider Demographics
NPI:1396436374
Name:NEVITT, NICOLE CHARLOTTE (MS, LGC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHARLOTTE
Last Name:NEVITT
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PACIFICA APT 5238
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3356
Mailing Address - Country:US
Mailing Address - Phone:415-302-8181
Mailing Address - Fax:
Practice Address - Street 1:25 PACIFICA APT 5238
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3356
Practice Address - Country:US
Practice Address - Phone:415-302-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001733170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS