Basic Information
| Provider Information | |||||||||
| NPI: | 1437620549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | THERESA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LIFESTYLE COACH- RMA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 750 W HIGH ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458013959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965630 | ||||||||
| FaxNumber: | 4199965424 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 W HIGH ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458013959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199965630 | ||||||||
| FaxNumber: | 4199965424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174H00000X | Y | Other Service Providers | Health Educator |
No ID Information.