Healthcare Provider Details

I. General information

NPI: 1952880841
Provider Name (Legal Business Name): NICOLE SUE INSKEEP LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WILSON ST
WINGATE NC
28174
US

IV. Provider business mailing address

612 N MAIN ST
WINGATE NC
28174-6760
US

V. Phone/Fax

Practice location:
  • Phone: 704-233-8165
  • Fax:
Mailing address:
  • Phone: 515-419-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-3955
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: