Provider Demographics
NPI:1033957121
Name:MADIGAN, NICHOLE MARIE
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:MARIE
Last Name:MADIGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:NIKKI
Other - Middle Name:MARIE
Other - Last Name:MADIGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3491 KURTZ ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-4430
Mailing Address - Country:US
Mailing Address - Phone:619-276-1176
Mailing Address - Fax:
Practice Address - Street 1:3491 KURTZ ST STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4430
Practice Address - Country:US
Practice Address - Phone:619-276-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator