Provider Demographics
NPI:1447676929
Name:HUNTER, NICOLE MICHELLE
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MICHELLE
Last Name:HUNTER
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 1:17230 NAVAJO TRL
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9104
Mailing Address - Country:US
Mailing Address - Phone:269-547-9745
Mailing Address - Fax:
Practice Address - Street 1:2575 N DRAKE RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-1358
Practice Address - Country:US
Practice Address - Phone:269-342-0206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-08
Last Update Date:2014-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502002418225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant