Provider Demographics
NPI:1699265033
Name:PERSING-WETHINGTON, NICOLE MARIE (RYT-200)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:PERSING-WETHINGTON
Suffix:
Gender:F
Credentials:RYT-200
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NORWAY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-1719
Mailing Address - Country:US
Mailing Address - Phone:989-344-3264
Mailing Address - Fax:
Practice Address - Street 1:501 NORWAY ST STE 2
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-1719
Practice Address - Country:US
Practice Address - Phone:989-344-3264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker