Provider Demographics
NPI:1457871162
Name:NICKEL, URSULA MARIA LUISE (DOM)
Entity Type:Individual
Prefix:
First Name:URSULA
Middle Name:MARIA LUISE
Last Name:NICKEL
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3212 MONTE VISTA BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2120
Mailing Address - Country:US
Mailing Address - Phone:505-379-8525
Mailing Address - Fax:
Practice Address - Street 1:3212 MONTE VISTA BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2120
Practice Address - Country:US
Practice Address - Phone:505-379-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM698171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist