Healthcare Provider Details

I. General information

NPI: 1710894449
Provider Name (Legal Business Name): ASHLEY ELIZABETH NICHOLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E GATE CITY BLVD
GREENSBORO NC
27406-1457
US

IV. Provider business mailing address

5508 EDGEBURY RD
RALEIGH NC
27613-5514
US

V. Phone/Fax

Practice location:
  • Phone: 336-375-9232
  • Fax:
Mailing address:
  • Phone: 704-575-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number320966
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: