Provider Demographics
NPI:1992942452
Name:BARNARD, NICOLE (DOM)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BARNARD
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 JUAN TABO BLVD NE STE 117
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1885
Mailing Address - Country:US
Mailing Address - Phone:404-695-0842
Mailing Address - Fax:
Practice Address - Street 1:2901 JUAN TABO BLVD NE STE 117
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1885
Practice Address - Country:US
Practice Address - Phone:505-275-9602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-20
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
GA000232171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty