Provider Demographics
NPI:1891415188
Name:RACICOT, NICOLE L (IHP L2)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:RACICOT
Suffix:
Gender:F
Credentials:IHP L2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 LITTLE GULLY RUN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-9371
Mailing Address - Country:US
Mailing Address - Phone:406-599-4630
Mailing Address - Fax:
Practice Address - Street 1:8383 LITTLE GULLY RUN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-9371
Practice Address - Country:US
Practice Address - Phone:406-599-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach