Provider Demographics
NPI:1497298533
Name:ADAMS, NICOLE (LMP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:TOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 WENCKER CIR
Mailing Address - Street 2:APT C
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-5809
Mailing Address - Country:US
Mailing Address - Phone:413-658-7108
Mailing Address - Fax:
Practice Address - Street 1:123 WENCKER CIR
Practice Address - Street 2:APT C
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-5809
Practice Address - Country:US
Practice Address - Phone:413-658-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60431148225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist