Provider Demographics
NPI:1306690789
Name:KRAFT, NICHOLE MARIE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:KRAFT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14651 S BASCOM AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2004
Mailing Address - Country:US
Mailing Address - Phone:408-356-9013
Mailing Address - Fax:
Practice Address - Street 1:14651 S BASCOM AVE STE 120
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2004
Practice Address - Country:US
Practice Address - Phone:408-356-9013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029278363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner