Provider Demographics
NPI:1780988923
Name:STROMBERG, NICOLE LAROE (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LAROE
Last Name:STROMBERG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 DENNIS CHAVEZ BLVD SW
Mailing Address - Street 2:ATRISCO HERITAGE CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87121-5498
Mailing Address - Country:US
Mailing Address - Phone:505-272-6009
Mailing Address - Fax:
Practice Address - Street 1:10800 DENNIS CHAVEZ BLVD SW
Practice Address - Street 2:ATRISCO HERITAGE CLINIC,
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5498
Practice Address - Country:US
Practice Address - Phone:505-272-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2013-0066363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical