Individual
LINDA A NICOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
201 CEDAR ST SE STE 4660, ALBUQUERQUE, NM 87106-4924
(505) 563-6530
(505) 563-6336
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
(505) 923-6770
(505) 923-5354
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
204554
NY
2086S0120X
Pediatric Surgery Physician
204554
NY
2086S0120X
Pediatric Surgery Physician
Primary
91-101
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01690293
—
NY
05
—
56509766
—
NM
Enumeration date
06/16/2006
Last updated
03/25/2016
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