Provider Demographics
NPI:1902870041
Name:SINGER, NICOLE T (PA C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:T
Last Name:SINGER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:T
Other - Last Name:CZARNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 63362
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3362
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:3700 NW CARY PKWY
Practice Address - Street 2:SUITE 110
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8446
Practice Address - Country:US
Practice Address - Phone:919-238-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001407363AM0700X
NC1046230363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
55681OtherWELLMARK
55682OtherWELLMARK
55683OtherWELLMARK
IA1117994Medicaid
IA2117994Medicaid
55682OtherWELLMARK
I6688Medicare ID - Type Unspecified
55681OtherWELLMARK
55683OtherWELLMARK