Provider Demographics
NPI:1083472880
Name:MORIGEAU, NICOLE KRISTEN (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KRISTEN
Last Name:MORIGEAU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 N ETHERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8526
Mailing Address - Country:US
Mailing Address - Phone:928-800-4460
Mailing Address - Fax:
Practice Address - Street 1:7485 E 1ST ST STE G
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2241
Practice Address - Country:US
Practice Address - Phone:928-800-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist