Provider Demographics
NPI:1184834558
Name:HAHNE, NICOLE LEA (LATC)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LEA
Last Name:HAHNE
Suffix:
Gender:F
Credentials:LATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27380 SD HWY 20
Mailing Address - Street 2:
Mailing Address - City:TRAIL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57657
Mailing Address - Country:US
Mailing Address - Phone:605-845-7004
Mailing Address - Fax:
Practice Address - Street 1:906 MAIN ST
Practice Address - Street 2:
Practice Address - City:TIMBER LAKE
Practice Address - State:SD
Practice Address - Zip Code:57656
Practice Address - Country:US
Practice Address - Phone:605-865-3258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD01952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer