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NPI Code Detail

MEDICARE: DR. KATELYN ELLEN NICHOLS PHARMD

MEDICARE: DR. KATELYN ELLEN NICHOLS PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11835P2201XAmbulatory Care Pharmacist051295914IL
21835P2201XAmbulatory Care Pharmacist2298940WI

General Provider Information

NPI Number : 1093062424
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATELYN ELLEN NICHOLS PHARMD
Provider Business Mailing Address
First Line : 2851 UNIVERSITY AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-5855
Country : US
Telephone Number : 920-431-2500
Fax Number :
Provider Business Practice Location Address
First Line : 2851 UNIVERSITY AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54311-5855
Country : US
Telephone Number : 920-431-2500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2012
Last Update Date : 05/26/2026

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Directions to “ DR. KATELYN ELLEN NICHOLS PHARMD” Practice Location

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