Provider Demographics
NPI:1366704462
Name:LENNOX, NICOLE (LMT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LENNOX
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 1:3093 SASHABAW RD
Mailing Address - Street 2:STE A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48329-4089
Mailing Address - Country:US
Mailing Address - Phone:248-509-4433
Mailing Address - Fax:248-284-4358
Practice Address - Street 1:3093 SASHABAW RD
Practice Address - Street 2:STE A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48329-4089
Practice Address - Country:US
Practice Address - Phone:248-509-4433
Practice Address - Fax:248-284-4358
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002344225700000X, 225700000X
374J00000X, 374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes374J00000XNursing Service Related ProvidersDoula