Provider Demographics
NPI:1740627330
Name:DAWIS, NICOLE ALBRECHT (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALBRECHT
Last Name:DAWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:MICHELLE
Other - Last Name:ALBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:324 E 10TH AVE STE 178
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2885
Mailing Address - Country:US
Mailing Address - Phone:801-408-8500
Mailing Address - Fax:801-408-8510
Practice Address - Street 1:324 E 10TH AVE STE 178
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2885
Practice Address - Country:US
Practice Address - Phone:801-408-8500
Practice Address - Fax:801-408-8510
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43011029712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry