Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PP4162 | NC |
Y | 103TC0700X | Clinical Psychologist | PP4162 | NC |
NPI | 1932449832 |
---|---|
Provider Name | Dr. Nicole Danielle Pukay-Martin |
First Address | Fort Thomas, KY 41075-2305 |
Second Address | Fort Thomas, KY 41075-2305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2013 |
Last Update Date | 11/01/2021 |