Provider Demographics
NPI:1821418997
Name:ATKINSON, NICOLE NAOMI (LMP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:NAOMI
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 E MARIETTA AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2743
Mailing Address - Country:US
Mailing Address - Phone:509-999-1223
Mailing Address - Fax:
Practice Address - Street 1:2911 W NORTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2378
Practice Address - Country:US
Practice Address - Phone:509-999-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60460969225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist