Nicole Renee Wisda, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

750100714 Issued in MI

Practice address

G3277 Beecher Rd
Flint, MI 48532-3615

Phone

(810) 282-4278

NPI assigned

Apr 22, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Core Healing Bodyworks

  • Clinic/Center
  • Flint, MI
  • NPI 1891156139
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1932781663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "G3277 BEECHER RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323615",
            "telephone_number": "810-282-4278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "G3277 BEECHER RD",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485323615",
            "telephone_number": "810-282-4278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISDA",
        "first_name": "NICOLE",
        "middle_name": "RENEE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-22",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "750100714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Dropbox",
            "affiliation": "N",
            "address_1": "G3277 Beecher Rd",
            "city": "Flint",
            "state": "MI",
            "country_code": "US",
            "postal_code": "485323615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amber Wing
• Aaron Winston, LBSW
• Mildred Rose Wint, RD
• Terri R. Winterlee, CRNA
• Brianna Marie Winters
• Giovanna Andria Wise, LPC
• Wish Granted
• Brian Wisniewski
• Kathryn M Wisser, DO
• Kenneth J. Wisser, D.M.D.

• Massage Therapist in Flint, MI
• Providers in Flint, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.