Provider Demographics
NPI:1184961617
Name:NEELY, NICOLE N (LMT)
Entity type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:N
Last Name:NEELY
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 1:11330 CHERRY HILL RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-3723
Mailing Address - Country:US
Mailing Address - Phone:212-203-6998
Mailing Address - Fax:
Practice Address - Street 1:11330 CHERRY HILL RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3723
Practice Address - Country:US
Practice Address - Phone:212-203-6998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM04409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist