Healthcare Provider Details

I. General information

NPI: 1841582053
Provider Name (Legal Business Name): NICOLE A LINK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 S KNOXVILLE AVE STE A
SAINT MARYS OH
45885-2609
US

IV. Provider business mailing address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-394-9959
  • Fax: 419-394-0255
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-394-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.12427
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number347337
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: