Provider Demographics
NPI:1205960937
Name:CYPHERT, NICOLE ERICA (MS OTR L)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:ERICA
Last Name:CYPHERT
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34035
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28234-4035
Mailing Address - Country:US
Mailing Address - Phone:704-248-1146
Mailing Address - Fax:187-726-8534
Practice Address - Street 1:5407 CANIPE FARM CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-5029
Practice Address - Country:US
Practice Address - Phone:704-248-1146
Practice Address - Fax:187-726-8534
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC144CJMedicare UPIN
NC7208893Medicare UPIN
NC11647338Medicare UPIN