Healthcare Provider Details

I. General information

NPI: 1396322475
Provider Name (Legal Business Name): MARGARET M NICHOLSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 W WASHINGTON BLVD UNIT 6D
CHICAGO IL
60607-2112
US

IV. Provider business mailing address

4052 GRAND AVE
WESTERN SPRGS IL
60558-1135
US

V. Phone/Fax

Practice location:
  • Phone: 708-670-0797
  • Fax:
Mailing address:
  • Phone: 708-670-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN1003X
TaxonomyNutrition Support Registered Nurse
License Number495610
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: