Healthcare Provider Details

I. General information

NPI: 1174222848
Provider Name (Legal Business Name): WILLIAM NICHOLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MAGNOLIA LN
EXETER NH
03833-2526
US

IV. Provider business mailing address

30 MAGNOLIA LN
EXETER NH
03833-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-772-2710
  • Fax:
Mailing address:
  • Phone: 603-772-2710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number069188-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number069188-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: