Provider Demographics
NPI:1053900431
Name:LEONEL, NICOLE GABRIELLE (DACM, LAC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GABRIELLE
Last Name:LEONEL
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:GABRIELLE LEONEL
Other - Last Name:SALLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7112 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIO LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95673-2251
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:53 OLD SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3872
Practice Address - Country:US
Practice Address - Phone:410-263-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02789171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist