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NPI Code Detail

MEDICARE: NICOLE MARIE YASSINE L.OM

MEDICARE: NICOLE MARIE YASSINE L.OM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistOM000240PA

General Provider Information

NPI Number : 1619521218
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE YASSINE L.OM
Provider Business Mailing Address
First Line : 1731 RIDGE AVE # C-2
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19130-1538
Country : US
Telephone Number : 860-995-5987
Fax Number :
Provider Business Practice Location Address
First Line : 2308 GRAYS FERRY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19146-1177
Country : US
Telephone Number : 215-772-0770
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2019
Last Update Date : 07/31/2019

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