Provider Demographics
NPI:1194096743
Name:KNOTTS, NICOLE VERLEAN (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:VERLEAN
Last Name:KNOTTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3132 W MARCH LN
Mailing Address - Street 2:SUITE 5
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2354
Mailing Address - Country:US
Mailing Address - Phone:209-475-5500
Mailing Address - Fax:209-475-5515
Practice Address - Street 1:3132 W MARCH LN
Practice Address - Street 2:SUITE 5
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2354
Practice Address - Country:US
Practice Address - Phone:209-475-5500
Practice Address - Fax:209-475-5515
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2013-09-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA124373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine