MEDICARE: HOLLY NICOLE LIGNELL CMT

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
1	175L00000X	Homeopath

General Provider Information

NPI Number	:	1649571670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY NICOLE LIGNELL CMT

Provider Business Mailing Address
First Line	:	2918 DIVISION ST
Second Line	:	SUITE C
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2437
Country	:	US
Telephone Number	:	269-369-2988
Fax Number	:

Provider Business Practice Location Address
First Line	:	2918 DIVISION ST
Second Line	:	SUITE C
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-2437
Country	:	US
Telephone Number	:	269-369-2988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2010
Last Update Date	:	11/08/2010

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