Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1083806137 |
---|---|
Provider Name | Dr. Nicole E. Anderson |
First Address | Tucson, AZ 85743-1408 |
Second Address | Marana, AZ 85653-9609 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 13/08/2007 |