Individual
NICHELLE ELISE WHITEHEAD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2034 N 3RD STREET, PHOENIX, AZ 85004
(602) 288-0777
(602) 340-0398
Mailing address
2034 N 3RD STREET, PHOENIX, AZ 85004
(602) 288-0777
(602) 340-0398
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
25151
AZ
207V00000X
Obstetrics & Gynecology Physician
MD00036678
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
596380
—
AZ
01
—
AZ0895360
BC
AZ
Enumeration date
03/07/2006
Last updated
07/08/2007
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