Healthcare Provider Details

I. General information

NPI: 1679116248
Provider Name (Legal Business Name): DAHLIA M NICHOLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1663 E 17TH ST
BROOKLYN NY
11229-1259
US

IV. Provider business mailing address

69 MCNOMEE ST
OAKLAND NJ
07436-2608
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-0200
  • Fax:
Mailing address:
  • Phone: 929-271-7316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number546818
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: