Healthcare Provider Details

I. General information

NPI: 1851218960
Provider Name (Legal Business Name): NICOLE FREDERICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E MAIN ST
COLUMBUS OH
43215-5222
US

IV. Provider business mailing address

525 E MOUND ST FL 2
COLUMBUS OH
43215-5540
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4867
  • Fax:
Mailing address:
  • Phone: 337-467-2073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN.443925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: