Provider Demographics
NPI:1215139308
Name:SANTORO, NICHOLE MICHELLE (LAC, LMT)
Entity type:Individual
Prefix:MISS
First Name:NICHOLE
Middle Name:MICHELLE
Last Name:SANTORO
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19820 62ND AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-8618
Mailing Address - Country:US
Mailing Address - Phone:425-830-0358
Mailing Address - Fax:
Practice Address - Street 1:12006 NE 98TH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034
Practice Address - Country:US
Practice Address - Phone:425-280-1643
Practice Address - Fax:425-820-1645
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist