Provider Demographics
NPI:1982808846
Name:BANH, NICOLE TERE (MD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:TERE
Last Name:BANH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:T
Other - Last Name:BIRMINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7055 N CHESTNUT AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0350
Mailing Address - Country:US
Mailing Address - Phone:559-797-4400
Mailing Address - Fax:559-797-4401
Practice Address - Street 1:7055 N CHESTNUT AVE STE 106
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0350
Practice Address - Country:US
Practice Address - Phone:559-797-4400
Practice Address - Fax:559-797-4401
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics