Healthcare Provider Details

I. General information

NPI: 1447065263
Provider Name (Legal Business Name): PAMELA LOUISE NICHOLS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S CAYUGA RD
WILLIAMSVILLE NY
14221-6728
US

IV. Provider business mailing address

71 AVALON MEADOWS LN
EAST AMHERST NY
14051-2931
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-1088
  • Fax:
Mailing address:
  • Phone: 919-628-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number738197-01
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number738197-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: