Individual
NICHOLE EASTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1905 W 57TH ST ST 3, SIOUX FALLS, SD 57108
(605) 371-3533
(605) 371-1798
Mailing address
1905 W 57TH ST ST 3, SIOUX FALLS, SD 57108
(605) 371-3533
(605) 371-1781
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT11055
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11055
NON MEDICARE PROVIDER
SD
Enumeration date
12/15/2020
Last updated
12/16/2020
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