Provider Demographics
NPI:1093402208
Name:HITCHINGS, NICOLE GRACE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GRACE
Last Name:HITCHINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 VIENNA WOODS AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-5626
Mailing Address - Country:US
Mailing Address - Phone:330-206-8372
Mailing Address - Fax:
Practice Address - Street 1:2811 VIENNA WOODS AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-5626
Practice Address - Country:US
Practice Address - Phone:330-206-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSM978838172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty