Provider Demographics
NPI:1881478089
Name:SPINELLI-FUSON, NICOLE MARIE (HIS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SPINELLI-FUSON
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9700 FAIRWAY DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3604
Mailing Address - Country:US
Mailing Address - Phone:916-772-4327
Mailing Address - Fax:916-772-4328
Practice Address - Street 1:9700 FAIRWAY DR STE 120
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-3604
Practice Address - Country:US
Practice Address - Phone:916-772-4327
Practice Address - Fax:916-772-4328
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAD8737237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist