1114190972 NPI number — DR. NICOLE LEMIEUX WHITLATCH MD

Table of content: DR. NICOLE LEMIEUX WHITLATCH MD (NPI 1114190972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114190972 NPI number — DR. NICOLE LEMIEUX WHITLATCH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITLATCH
Provider First Name:
NICOLE
Provider Middle Name:
LEMIEUX
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEMIEUX
Provider Other First Name:
NICOLE
Provider Other Middle Name:
AUDET
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114190972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7555
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95927-7555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-332-4530
Provider Business Mailing Address Fax Number:
530-893-6984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 ESPLANADE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95926-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-332-4530
Provider Business Practice Location Address Fax Number:
530-893-6984
Provider Enumeration Date:
04/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A108945 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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