Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175L00000X | Homeopath | 7501008135 | MI |
Y | 225700000X | Massage Therapist | 7501008135 | MI |
NPI | 1972994697 |
---|---|
Provider Name | Nicole Scruggs |
First Address | Detroit, MI 48226-1400 |
Second Address | Detroit, MI 48226-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2015 |
Last Update Date | 26/05/2015 |