Provider Demographics
NPI:1619843471
Name:BOOD, NICOLE ENID (RN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ENID
Last Name:BOOD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:ENID
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6230 WILSHIRE BLVD STE A
Mailing Address - Street 2:PMB 2210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5126
Mailing Address - Country:US
Mailing Address - Phone:424-750-2420
Mailing Address - Fax:
Practice Address - Street 1:6230 WILSHIRE BLVD STE A
Practice Address - Street 2:PMB 2210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5126
Practice Address - Country:US
Practice Address - Phone:424-750-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9579914163W00000X
CA95247633163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty