Provider Demographics
NPI:1225846207
Name:NOURI, NICKI PERSIA (NP)
Entity type:Individual
Prefix:MS
First Name:NICKI
Middle Name:PERSIA
Last Name:NOURI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22770 CHARLEMONT PL
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4914
Mailing Address - Country:US
Mailing Address - Phone:818-521-8803
Mailing Address - Fax:
Practice Address - Street 1:22770 CHARLEMONT PL
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4914
Practice Address - Country:US
Practice Address - Phone:818-521-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95030290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty