Provider Demographics
NPI:1033837547
Name:NUBIANCE INC
Entity Type:Organization
Organization Name:NUBIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:SHENISE
Authorized Official - Last Name:BACCHUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-327-0228
Mailing Address - Street 1:N103W14660 HAWKEYE CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-5335
Mailing Address - Country:US
Mailing Address - Phone:262-327-0228
Mailing Address - Fax:
Practice Address - Street 1:N103W14660 HAWKEYE CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-5335
Practice Address - Country:US
Practice Address - Phone:262-327-0228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty