Provider Demographics
NPI:1568051068
Name:KAMINSKI, NOELLE (MAT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 RUNAWAY BAY DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8749
Mailing Address - Country:US
Mailing Address - Phone:586-907-8144
Mailing Address - Fax:
Practice Address - Street 1:206 PAGE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2418
Practice Address - Country:US
Practice Address - Phone:517-783-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program