Healthcare Provider Details

I. General information

NPI: 1366229395
Provider Name (Legal Business Name): NICOLE DORAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 1ST CAPITOL DR STE 203&204
SAINT CHARLES MO
63301-2734
US

IV. Provider business mailing address

3541 TARN ST
SAINT CHARLES MO
63301-8366
US

V. Phone/Fax

Practice location:
  • Phone: 636-385-4559
  • Fax: 314-754-9560
Mailing address:
  • Phone: 636-385-4559
  • Fax: 314-754-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041484497
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2007023539
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number2007023539
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number2007023539
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: