Nicole Rae Bandstra
Individual provider Active NPI Massage Therapist · Pella, IA
NPI 1992583439 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1992583439
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- 006340 (IA)
- Practice address
- 110 E 10TH St
Pella, IA 50219-2002 - Phone
- (641) 278-5005
- NPI assigned
- Sep 18, 2023
- 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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006340 | IA | MD | Massage Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 006340 | IA | Yes |
Addresses
Primary practice location
110 E 10TH St
Pella, IA 50219-2002
Mailing address
PO Box 126
New Sharon, IA 50207-0126
Phone (641) 278-5005
Other providers in Pella, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.