Nichole Caudle, N.D., MT

Key facts

NPI

1831551977

Entity type

Individual (NPI type 1)

Primary specialty

Massage Therapist 225700000X

License

7501003942 (MI)

Practice address

1514 Wealthy St SE
Suite 218
Grand Rapids, MI 49506-2762

Phone

(616) 204-4003

NPI assigned

Mar 28, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Credentials

Medical Technician

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 28, 2016.

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459123200000",
    "number": "1831551977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE",
            "address_2": "SUITE 218",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 WEALTHY ST SE",
            "address_2": "SUITE 218",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495062762",
            "telephone_number": "616-204-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAUDLE",
        "first_name": "NICHOLE",
        "credential": "N.D., MT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-03-28",
        "last_updated": "2016-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501003942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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