Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 174N00000X | Lactation Consultant | ||
Y | 225700000X | Massage Therapist | 7501002344 | MI |
NPI | 1366704462 |
---|---|
Provider Name | Nicole Lennox |
First Address | Waterford, MI 48329-4089 |
Second Address | Waterford, MI 48329-4089 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2012 |
Last Update Date | 02/11/2016 |