Provider Demographics
NPI:1265979900
Name:BARTREAU, NICOLE (FNP, PMHNP, IBCLC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BARTREAU
Suffix:
Gender:F
Credentials:FNP, PMHNP, IBCLC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:SHEETS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:929 N. VAL VISTA DR.
Mailing Address - Street 2:STE 109 #1299
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3701
Mailing Address - Country:US
Mailing Address - Phone:480-818-9188
Mailing Address - Fax:
Practice Address - Street 1:333 N DOBSON RD STE 5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-4412
Practice Address - Country:US
Practice Address - Phone:480-227-7525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-19
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN181769163W00000X
AZL87257163WL0100X
AZAP9807363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ238967Medicaid