Healthcare Provider Details

I. General information

NPI: 1285763102
Provider Name (Legal Business Name): EVELYN LORRAINE NICHOLS LICENSED INDEPENDENT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 14TH STREET NW FIRST HOME CARE
WASHINGTON DC
20005
US

IV. Provider business mailing address

6009 43RD STREET
HYATTSVILLE MD
20781-1510
US

V. Phone/Fax

Practice location:
  • Phone: 202-737-2554
  • Fax: 202-737-3261
Mailing address:
  • Phone: 301-927-0427
  • Fax: 301-927-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLI200152
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: