Active NPI
Nicole Bain, LE
- Specialist
- Elk Grove, CA
National Provider Identifier
1588387369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- L9771
- Practice address
- 9117 E Stockton Blvd, Unit 100, Suite 19
Elk Grove, CA 95624 - Phone
- (209) 294-0634
- NPI assigned
- Sep 26, 2022
- Last updated
- May 23, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | L9771 | CA | Primary |
Addresses
Primary practice location
9117 E Stockton Blvd, Unit 100, Suite 19
Elk Grove, CA 95624
Mailing address
2256 Heavenly Way
Lodi, CA 95242-4490
Phone (209) 274-7857
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L9771 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nicoles Electrolysis, Inc. | Specialist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716422400000",
"number": "1588387369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2256 HEAVENLY WAY",
"city": "LODI",
"state": "CA",
"postal_code": "952424490",
"telephone_number": "209-274-7857"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9117 E STOCKTON BLVD, UNIT 100, SUITE 19",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "95624",
"telephone_number": "209-294-0634"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAIN",
"first_name": "NICOLE",
"credential": "LE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2024-05-23",
"certification_date": "2024-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "CA",
"license": "L9771",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.