Provider Demographics
NPI:1457860686
Name:WIECKS, NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:WIECKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 CONCORD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9208
Mailing Address - Country:US
Mailing Address - Phone:530-487-7061
Mailing Address - Fax:
Practice Address - Street 1:1811 CONCORD AVE STE 100
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9208
Practice Address - Country:US
Practice Address - Phone:530-487-7061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A244862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry