Provider Demographics
NPI:1194257816
Name:HANDY, NICKETTI MARIE (MD)
Entity type:Individual
Prefix:
First Name:NICKETTI
Middle Name:MARIE
Last Name:HANDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 S BUENA VISTA ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4504
Mailing Address - Country:US
Mailing Address - Phone:818-847-3781
Mailing Address - Fax:818-572-9420
Practice Address - Street 1:181 S BUENA VISTA ST FL 3
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4504
Practice Address - Country:US
Practice Address - Phone:818-847-3781
Practice Address - Fax:818-572-9420
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA188123208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program