Provider Demographics
NPI:1740615483
Name:CARNESI, NICHOLE (LMT)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:CARNESI
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 1:1831 SE 7TH AVE
Mailing Address - Street 2:#201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1831 SE 7TH AVE
Practice Address - Street 2:#201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3578
Practice Address - Country:US
Practice Address - Phone:503-766-3664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13031225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist