MEDICARE: CHARTER L 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
1	237700000X	Hearing Instrument Specialist	1584	NC

General Provider Information

NPI Number	:	1437791597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARTER L NICHOLSON

Provider Business Mailing Address
First Line	:	2501 COTTONTAIL LN
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-5125
Country	:	US
Telephone Number	:	732-529-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	1970 W ARLINGTON BLVD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5783
Country	:	US
Telephone Number	:	252-830-0400
Fax Number	:

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

Provider Enumeration Date	:	10/10/2019
Last Update Date	:	10/10/2019

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