Provider Demographics
NPI:1750778437
Name:MACCLEARY PRICE, NICOLE LORRAINE (DO)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LORRAINE
Last Name:MACCLEARY PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15396 N 83RD AVE STE F100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5629
Mailing Address - Country:US
Mailing Address - Phone:602-595-9696
Mailing Address - Fax:
Practice Address - Street 1:15396 N 83RD AVE STE F100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5629
Practice Address - Country:US
Practice Address - Phone:602-595-9696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ007866207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty