Provider Demographics
NPI:1700263365
Name:PITTS-MALDONADO, NICHOL (HAIR LOSS SPECIALIST)
Entity type:Individual
Prefix:
First Name:NICHOL
Middle Name:
Last Name:PITTS-MALDONADO
Suffix:
Gender:F
Credentials:HAIR LOSS SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 CONCORD MILLS BLVD
Mailing Address - Street 2:212
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-5400
Mailing Address - Country:US
Mailing Address - Phone:704-488-9897
Mailing Address - Fax:
Practice Address - Street 1:5326 PROSPERITY RIDGE RD APT 105
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-0182
Practice Address - Country:US
Practice Address - Phone:704-488-9897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNH 23541744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management