Individual
NICOLE ALISSA DEATHERAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 N CAMPBELL AVE, TUCSON, AZ 85719-4330
(520) 626-6830
Mailing address
1501 N CAMPBELL AVE, TUCSON, AZ 85724-5108
(520) 626-6830
(520) 626-2521
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
R79300
AZ
Other
Enumeration date
04/26/2022
Last updated
04/26/2022
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