MEDICARE: WHITNEY NICHOLSON RN

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	163WG0000X	General Practice Registered Nurse	RN132219	LA

General Provider Information

NPI Number	:	1912634189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY NICHOLSON RN

Provider Business Mailing Address
First Line	:	72240 DOGWOOD RD
Second Line	:
City	:	ABITA SPRINGS
State	:	LA
Zip	:	70420-2966
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	72240 DOGWOOD RD
Second Line	:
City	:	ABITA SPRINGS
State	:	LA
Zip	:	70420-2966
Country	:	US
Telephone Number	:	985-807-8148
Fax Number	:

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

Provider Enumeration Date	:	08/06/2022
Last Update Date	:	08/06/2022

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