Basic Information
| Provider Information | |||||||||
| NPI: | 1699185660 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ROCKEFELLER | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | F. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 CLAYTON RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631171811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147688000 | ||||||||
| FaxNumber: | 3146458771 | ||||||||
| Practice Location | |||||||||
| Address1: | 6100 PAN AMERICAN FREEWAY NE | ||||||||
| Address2: | STE 450 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871093460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058238787 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2014 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 2014020090 | MO | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VF0040X | RS2018-0404 | NM | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery | 390200000X | NM | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207VF0040X | MD2021-0817 | NM | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
No ID Information.