Provider Demographics
NPI:1740776491
Name:ROTHWELL-NIKOI, LAPRESE MICHELLE
Entity Type:Individual
Prefix:
First Name:LAPRESE
Middle Name:MICHELLE
Last Name:ROTHWELL-NIKOI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2935
Mailing Address - Country:US
Mailing Address - Phone:484-802-5333
Mailing Address - Fax:484-462-3329
Practice Address - Street 1:1018 ELSINORE PL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-6315
Practice Address - Country:US
Practice Address - Phone:610-874-7849
Practice Address - Fax:484-461-3537
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA143620324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA143620OtherCOMMUNITY RESIDENTIAL REHABILITATION SVC LICENSE