Provider Demographics
NPI:1174190938
Name:TOWNSEND, NICHOLE MONQUIE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MONQUIE
Last Name:TOWNSEND
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 1:4414 N LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-2353
Mailing Address - Country:US
Mailing Address - Phone:419-936-4671
Mailing Address - Fax:
Practice Address - Street 1:4414 N LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-2353
Practice Address - Country:US
Practice Address - Phone:419-936-4671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty