Individual
MS. NICOLE BANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
811 RUSSELL AVE STE B, GAITHERSBURG, MD 20879-3524
(240) 418-8655
Mailing address
10 STONEY POINT CT, GERMANTOWN, MD 20876-5565
(240) 418-8655
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
M03967
MD
Other
Enumeration date
06/16/2009
Last updated
06/16/2009
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