Provider Demographics
NPI:1295607455
Name:WILLIAMS, NICHOLAS DUANE (LMT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DUANE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8686 HOLMES HWY
Mailing Address - Street 2:
Mailing Address - City:EATON RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:48827-9581
Mailing Address - Country:US
Mailing Address - Phone:917-371-0908
Mailing Address - Fax:
Practice Address - Street 1:2600 EATON RAPIDS RD STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-6354
Practice Address - Country:US
Practice Address - Phone:517-887-7599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.018673225700000X
MI7501013052225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist