Provider Demographics
NPI:1801171871
Name:GERARD, NICOLE HELEN (ND)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:HELEN
Last Name:GERARD
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 W GROVE PKWY
Mailing Address - Street 2:APT 3097
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-8440
Mailing Address - Country:US
Mailing Address - Phone:815-953-5783
Mailing Address - Fax:
Practice Address - Street 1:4657 S LAKESHORE DR
Practice Address - Street 2:SUITE 1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7170
Practice Address - Country:US
Practice Address - Phone:480-284-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1261175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath