Provider Demographics
NPI:1396522595
Name:RECANZONE, NICOLE DELIMA
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:DELIMA
Last Name:RECANZONE
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 1:1810 THRELKEL ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-3713
Mailing Address - Country:US
Mailing Address - Phone:775-325-8220
Mailing Address - Fax:
Practice Address - Street 1:1810 THRELKEL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-3713
Practice Address - Country:US
Practice Address - Phone:775-325-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator