Provider Demographics
NPI:1730624297
Name:ADAMS, NICOLE (RCIS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:RCIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57107-0404
Mailing Address - Country:US
Mailing Address - Phone:720-810-3891
Mailing Address - Fax:
Practice Address - Street 1:6308 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57107-0404
Practice Address - Country:US
Practice Address - Phone:720-810-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00052306246XC2901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist