Provider Demographics
NPI:1770711079
Name:OSWALT, NICOLE S (CPNP)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:S
Last Name:OSWALT
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2827
Mailing Address - Street 2:APT 7
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88004-2827
Mailing Address - Country:US
Mailing Address - Phone:575-532-1001
Mailing Address - Fax:575-532-5003
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-532-8900
Practice Address - Fax:575-532-8963
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2016-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMCNP-01500363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics