Provider Demographics
NPI:1083898357
Name:HEMMINGER, NICOLE M (LMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:HEMMINGER
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1527
Mailing Address - Country:US
Mailing Address - Phone:360-805-1555
Mailing Address - Fax:360-805-9029
Practice Address - Street 1:365 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1527
Practice Address - Country:US
Practice Address - Phone:360-805-1555
Practice Address - Fax:360-805-9029
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist