MEDICARE: MRS. DEBORAH DELEE NICHOLSON MS

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
1	231H00000X	Audiologist	50489	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396910113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBORAH DELEE NICHOLSON MS

Provider Business Mailing Address
First Line	:	2935 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-985-2529
Fax Number	:	409-985-3565

Provider Business Practice Location Address
First Line	:	2935 PARK PLAZA LN
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77642-5516
Country	:	US
Telephone Number	:	409-985-2529
Fax Number	:	409-985-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	01/31/2011

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