Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | TX 1062 | TX |
N | 222Z00000X | Podiatrist | TX 1062 | TX |
Y | 224P00000X | Prosthetist | TX 1062 | TX |
NPI | 1407089006 |
---|---|
Provider Name | Denise Nickel |
First Address | Arlington, TX 76015-2934 |
Second Address | Arlington, TX 76015-2934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2009 |
Last Update Date | 28/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
133334604 | (05) | TX |