Healthcare Provider Details

I. General information

NPI: 1699603241
Provider Name (Legal Business Name): ELIZABETH MARIE NICOLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W FRONT ST APT 3
LOGAN OH
43138-1638
US

IV. Provider business mailing address

507 W FRONT ST APT 3
LOGAN OH
43138-1638
US

V. Phone/Fax

Practice location:
  • Phone: 740-564-2037
  • Fax:
Mailing address:
  • Phone: 740-564-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: