Healthcare Provider Details

I. General information

NPI: 1972994697
Provider Name (Legal Business Name): NICOLE SCRUGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 BAGLEY ST SUITE 518
DETROIT MI
48226-1400
US

IV. Provider business mailing address

220 BAGLEY ST SUITE 518
DETROIT MI
48226-1400
US

V. Phone/Fax

Practice location:
  • Phone: 313-778-8501
  • Fax:
Mailing address:
  • Phone: 313-778-8501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number7501008135
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501008135
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: