Provider Demographics
NPI:1255687083
Name:DEMETRESCU, NICOLE P (PT)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:P
Last Name:DEMETRESCU
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:DANIELLE
Other - Last Name:PACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:209 MAIN AVE S
Mailing Address - Street 2:SUITE 111
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-8139
Mailing Address - Country:US
Mailing Address - Phone:425-888-3347
Mailing Address - Fax:425-888-3348
Practice Address - Street 1:209 MAIN AVE S
Practice Address - Street 2:SUITE 111
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8139
Practice Address - Country:US
Practice Address - Phone:425-888-3347
Practice Address - Fax:425-888-3348
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60283444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist