Provider Demographics
NPI:1407279268
Name:LENNON, NICOLE ELIZABETH (CNM)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH
Last Name:LENNON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 W WILLIAM CANNON DR
Mailing Address - Street 2:BLDG. 5 SUITE 503
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5257
Mailing Address - Country:US
Mailing Address - Phone:512-243-8066
Mailing Address - Fax:512-243-8591
Practice Address - Street 1:2500 W WILLIAM CANNON DR
Practice Address - Street 2:BLDG. 5 SUITE 503
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5257
Practice Address - Country:US
Practice Address - Phone:512-243-8066
Practice Address - Fax:512-243-8591
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX728869176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife