Provider Demographics
NPI:1932768116
Name:HESTER, NICOLE CHANELL
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CHANELL
Last Name:HESTER
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 1:3076 ALVINA AVE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-2498
Mailing Address - Country:US
Mailing Address - Phone:313-759-4526
Mailing Address - Fax:
Practice Address - Street 1:3076 ALVINA AVE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-2498
Practice Address - Country:US
Practice Address - Phone:313-759-4526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant