Individual
NICOLE VICIOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, PNP, CNS
Contact information
Practice address
455 S MAIN ST, ORANGE, CA 92868-3835
(714) 532-8421
Mailing address
111 38TH ST, UNIT B, NEWPORT BEACH, CA 92663-3060
(949) 646-1033
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
17971
CA
364SP0200X
Pediatric Clinical Nurse Specialist
1731
CA
Other
Enumeration date
07/21/2008
Last updated
07/21/2008
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