Provider Demographics
NPI:1366788283
Name:ROWE, NICOLE M (APRN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:M
Last Name:ROWE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 CAMINO MERCADO STE 536
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1814
Mailing Address - Country:US
Mailing Address - Phone:805-540-0279
Mailing Address - Fax:
Practice Address - Street 1:530 CAMINO MERCADO STE 536
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1814
Practice Address - Country:US
Practice Address - Phone:805-540-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-20
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95285393163W00000X
NV49458163W00000X
CA95021888363LP0808X
CA9502188363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse