Provider Demographics
NPI:1396116968
Name:RUFFIN, NICHOLE E J (LMT)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:E J
Last Name:RUFFIN
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 1:7211 HANOVER PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2090
Mailing Address - Country:US
Mailing Address - Phone:202-689-4585
Mailing Address - Fax:
Practice Address - Street 1:7211 HANOVER PKWY STE D
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2090
Practice Address - Country:US
Practice Address - Phone:202-689-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD4104225700000X
DCMT0886225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist