Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3524-146 | WI |
NPI | 1013503994 |
---|---|
Provider Name | Nicole Mann |
First Address | Manitowoc, WI 54220-3959 |
Second Address | Manitowoc, WI 54220-3959 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2020 |
Last Update Date | 16/12/2020 |