Provider Demographics
NPI:1750003257
Name:DUKES, NICOLE ELISE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELISE
Last Name:DUKES
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 1:19170 INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3206
Mailing Address - Country:US
Mailing Address - Phone:313-721-4907
Mailing Address - Fax:
Practice Address - Street 1:3970 W 24TH ST STE 108
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-9257
Practice Address - Country:US
Practice Address - Phone:928-783-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005255208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation