Provider Demographics
NPI:1265262190
Name:DYKES, NICOLE LINETTE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LINETTE
Last Name:DYKES
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 1:5879 DANIELS ST
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-1001
Mailing Address - Country:US
Mailing Address - Phone:734-369-0150
Mailing Address - Fax:
Practice Address - Street 1:5879 DANIELS ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-1001
Practice Address - Country:US
Practice Address - Phone:734-369-0150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID220630522785343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)