Provider Demographics
NPI:1639634272
Name:HOPPE, NICOLE KAY (LAT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:KAY
Last Name:HOPPE
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KAY
Other - Last Name:HOVANEC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAT
Mailing Address - Street 1:433 SOUTHTOWNE DR APT J208
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-4163
Mailing Address - Country:US
Mailing Address - Phone:414-852-4772
Mailing Address - Fax:
Practice Address - Street 1:433 SOUTHTOWNE DR APT J208
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-4163
Practice Address - Country:US
Practice Address - Phone:414-852-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1325-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer