Provider Demographics
NPI:1669924619
Name:HVID, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:HVID
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 1:3360 N HIGHWAY 59
Mailing Address - Street 2:SUITE K
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-9404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3360 N HIGHWAY 59
Practice Address - Street 2:SUITE K
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-9404
Practice Address - Country:US
Practice Address - Phone:209-726-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXXXXXXMedicare UPIN