Individual
NICOLETTE WHITESIDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 W BETHANY HOME RD, PHOENIX, AZ 85015-2443
(602) 923-5668
Mailing address
PO BOX 11475, CHANDLER, AZ 85248-0008
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN199765
AZ
367500000X
Certified Registered Nurse Anesthetist
Primary
CRNA298070
AZ
Other
Enumeration date
07/03/2023
Last updated
09/22/2023
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