Deatherage, Nicole Alissa
Deatherage, Nicole Alissa is an sole proprietor health care provider with primary practice located at 1625 N Campbell Ave , Tucson AZ 85719-4330. She recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as her primary health care specialty. Deatherage, Nicole Alissa can be contacted via phone (520) 626-6830.Contact Information
Primary practice address
1625 N Campbell Ave
Tucson AZ 85719-4330
Phone: (520) 626-6830
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology | 207ZP0102X | R79300 | Arizona |
Profile Details
| NPI number | 1417691338 |
|---|---|
| LBN Legal business name | Deatherage, Nicole Alissa |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Apr 26th, 2022 |
| Last updated | Apr 26th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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