Provider Demographics
NPI:1912526286
Name:DEHERDE, NICOLE JORDYN
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JORDYN
Last Name:DEHERDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4487 POST PL APT 49
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-1623
Mailing Address - Country:US
Mailing Address - Phone:908-914-1151
Mailing Address - Fax:
Practice Address - Street 1:4487 POST PL APT 49
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1623
Practice Address - Country:US
Practice Address - Phone:908-914-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program