Individual
DR. NICOLE PHOENIX ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
6501 4TH ST NW, F4, LOS RANCHOS, NM 87107-5800
(505) 344-9641
(505) 344-2621
Mailing address
PO BOX 66684, ALBUQUERQUE, NM 87193-6684
(505) 344-9641
(505) 344-2621
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0976
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39703754
—
NM
Enumeration date
06/01/2006
Last updated
06/20/2014
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