MEDICARE: NICOLE LYNNETTE JONES LMT

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	225700000X	Massage Therapist	2687	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2687	OTHER	NE	LICENSE

General Provider Information

NPI Number	:	1780983262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE LYNNETTE JONES LMT

Provider Business Mailing Address
First Line	:	3763 39TH AVE
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4504
Country	:	US
Telephone Number	:	402-606-4492
Fax Number	:	402-606-4168

Provider Business Practice Location Address
First Line	:	3763 39TH AVE
Second Line	:	SUITE 100
City	:	COLUMBUS
State	:	NE
Zip	:	68601-4504
Country	:	US
Telephone Number	:	402-606-4492
Fax Number	:	402-606-4168

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	03/23/2011

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