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NPI Code Detail

MEDICARE: TONYA NICHOLSON

MEDICARE: TONYA NICHOLSON
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
1374J00000XDoula

General Provider Information

NPI Number : 1154140440
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA NICHOLSON
Provider Business Mailing Address
First Line : 3043 SUPERIOR AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-4349
Country : US
Telephone Number : 330-760-3557
Fax Number :
Provider Business Practice Location Address
First Line : 3043 SUPERIOR AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-4349
Country : US
Telephone Number : 330-760-3557
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2024
Last Update Date : 10/16/2024

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Directions to “ TONYA NICHOLSON ” Practice Location

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