Basic Information
| Provider Information | |||||||||
| NPI: | 1801519764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALL | ||||||||
| FirstName: | NICOLE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9231 E MANNSIDING RD | ||||||||
| Address2: | |||||||||
| City: | CLARE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486179777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895062405 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 SW HOLDEN ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069337000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2022 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN61337970 | WA | Y | Nursing Service Providers | Registered Nurse |
No ID Information.