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General NPI Number Information
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NPI Number | 1881448603
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Entity Type | Individual
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Provider Name | NICOLE NOLA ROUSONELOS DAC
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Gender | Female
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 04/17/2024
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Provider Practice Location Address
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Address Line | 1339 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60660-1329
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Country | US
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Telephone | 773-293-7642
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Fax |
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Provider Business Mailing Address
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Address Line | 4535 N PAULINA ST APT 2D
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City | CHICAGO
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State | IL
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Zip | 60640-5326
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Country | US
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Telephone | 815-955-3591
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.001651
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License Number State | IL
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