Provider Demographics
NPI:1841835873
Name:WHITE-MUHAMMED, NICOLE S (CMA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:S
Last Name:WHITE-MUHAMMED
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:SHREE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MEDICAL ASSISTANT
Mailing Address - Street 1:16940 HIGHWAY 14 STE C-J
Mailing Address - Street 2:
Mailing Address - City:MOJAVE
Mailing Address - State:CA
Mailing Address - Zip Code:93501-1238
Mailing Address - Country:US
Mailing Address - Phone:661-824-5020
Mailing Address - Fax:
Practice Address - Street 1:16940 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MOJAVE
Practice Address - State:CA
Practice Address - Zip Code:93501-1238
Practice Address - Country:US
Practice Address - Phone:661-824-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty