Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 204554 | NY |
N | 208600000X | Surgeon | 204554 | NY |
N | 2086S0120X | Pediatric Surgery | 204554 | NY |
Y | 2086S0120X | Pediatric Surgery | 91-101 | NM |
NPI | 1265476550 |
---|---|
Provider Name | Linda A Nicolette |
First Address | Albuquerque, NM 87125-6666 |
Second Address | Albuquerque, NM 87106-4924 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 25/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01690293 | (05) | NY |
56509766 | (05) | NM |
G16650 | (02) |