Healthcare Provider Details

I. General information

NPI: 1821032426
Provider Name (Legal Business Name): PATRICIA DIANE NICHOLSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W. ROCHESTER STREET
AKRON IN
46910
US

IV. Provider business mailing address

PO BOX 966
WARSAW IN
46580
US

V. Phone/Fax

Practice location:
  • Phone: 574-372-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28061461A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: