Individual
NICHOLE BEULAH NESBITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3701 E BROADWAY AVE, APACHE JUNCTION, AZ 85119-9301
(480) 677-7519
Mailing address
9829 E BIRCHWOOD AVE, MESA, AZ 85208-1878
(623) 565-3500
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP048010
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D07954245
DRIVER LICENSE
AZ
Enumeration date
08/27/2018
Last updated
08/27/2018
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