Provider Demographics
NPI:1992326516
Name:NICK, DARCY LYNNE
Entity type:Individual
Prefix:
First Name:DARCY
Middle Name:LYNNE
Last Name:NICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DARCY
Other - Middle Name:LYNNE
Other - Last Name:KNAPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 HIGHGATE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5801
Mailing Address - Country:US
Mailing Address - Phone:303-256-2188
Mailing Address - Fax:
Practice Address - Street 1:1234 HIGHGATE RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5801
Practice Address - Country:US
Practice Address - Phone:303-256-2188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist