Healthcare Provider Details

I. General information

NPI: 1124095138
Provider Name (Legal Business Name): ANN MARIE NICHOLS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 STOCKTON BLVD STE 361
SACRAMENTO CA
95817-2208
US

IV. Provider business mailing address

2777 SANTA CLARA WAY
SACRAMENTO CA
95817-3049
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3189
  • Fax: 916-734-4757
Mailing address:
  • Phone: 916-734-3189
  • Fax: 916-734-4757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number620758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: