Provider Demographics
NPI:1215937842
Name:STORSETH, NICOLE JOY (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JOY
Last Name:STORSETH
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 1:4206 CALL FIELD RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2519
Mailing Address - Country:US
Mailing Address - Phone:940-397-5200
Mailing Address - Fax:940-367-5287
Practice Address - Street 1:4206 CALL FIELD RD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2519
Practice Address - Country:US
Practice Address - Phone:940-397-5200
Practice Address - Fax:940-367-5287
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H91057Medicare UPIN
TX8A9373Medicare ID - Type Unspecified