Provider Demographics
NPI:1275712846
Name:PAGANUCCI, NICOLE JEAN (LMT)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:JEAN
Last Name:PAGANUCCI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5716 207TH DR NE
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252-9462
Mailing Address - Country:US
Mailing Address - Phone:425-258-1168
Mailing Address - Fax:
Practice Address - Street 1:5716 207TH DR NE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-9462
Practice Address - Country:US
Practice Address - Phone:425-258-1168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-30
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019858225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist