Provider Demographics
NPI:1134589039
Name:TODD, NIKKEA CAMREN (LMT, MBA)
Entity type:Individual
Prefix:MRS
First Name:NIKKEA
Middle Name:CAMREN
Last Name:TODD
Suffix:
Gender:F
Credentials:LMT, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 SHERIDAN LINE RD
Mailing Address - Street 2:
Mailing Address - City:CROSWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48422-8341
Mailing Address - Country:US
Mailing Address - Phone:858-271-7000
Mailing Address - Fax:
Practice Address - Street 1:5590 MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-9383
Practice Address - Country:US
Practice Address - Phone:858-271-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501004130225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist