Provider Demographics
NPI:1457770521
Name:PINNOCK, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:PINNOCK
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 1:3105 NAYLOR RD SE
Mailing Address - Street 2:APT 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1679
Mailing Address - Country:US
Mailing Address - Phone:812-219-4345
Mailing Address - Fax:
Practice Address - Street 1:3105 NAYLOR RD SE
Practice Address - Street 2:APT 102
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-1679
Practice Address - Country:US
Practice Address - Phone:812-219-4345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No174H00000XOther Service ProvidersHealth Educator