Healthcare Provider Details

I. General information

NPI: 1831935733
Provider Name (Legal Business Name): NIKKO SELENE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43996 WOODWARD AVE STE 5
BLOOMFIELD HILLS MI
48302-5049
US

IV. Provider business mailing address

43996 WOODWARD AVE STE 5
BLOOMFIELD HILLS MI
48302-5049
US

V. Phone/Fax

Practice location:
  • Phone: 248-201-8293
  • Fax:
Mailing address:
  • Phone: 248-201-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: