Healthcare Provider Details

I. General information

NPI: 1770854127
Provider Name (Legal Business Name): PHYLLIS CHRISTINE NICHOLAS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

659 ABREGO ST SUITE 8
MONTEREY CA
93940-3238
US

IV. Provider business mailing address

659 ABREGO ST SUITE 8
MONTEREY CA
93940-3238
US

V. Phone/Fax

Practice location:
  • Phone: 831-717-4991
  • Fax: 831-717-4996
Mailing address:
  • Phone: 831-717-4991
  • Fax: 831-717-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number351225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: