Basic Information
| Provider Information | |||||||||
| NPI: | 1194480756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICDAO | ||||||||
| FirstName: | FRANCES | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716489202 | ||||||||
| Practice Location | |||||||||
| Address1: | 1244 N MARINE CORPS DR | ||||||||
| Address2: | |||||||||
| City: | TAMUNING | ||||||||
| State: | GU | ||||||||
| PostalCode: | 969134308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6716478262 | ||||||||
| FaxNumber: | 6716489202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2021 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | RX0758 | GU | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.