Healthcare Provider Details

I. General information

NPI: 1568306090
Provider Name (Legal Business Name): MR. ANDRELL NICHOLS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9824 LAUREL AVE
OMAHA NE
68134-1628
US

IV. Provider business mailing address

9824 LAUREL AVE
OMAHA NE
68134-1628
US

V. Phone/Fax

Practice location:
  • Phone: 402-990-2444
  • Fax:
Mailing address:
  • Phone: 402-990-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: