Healthcare Provider Details

I. General information

NPI: 1073889986
Provider Name (Legal Business Name): NICHOLE PINET R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 09/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 VANCE RD
SAINT PARIS OH
43072-9464
US

IV. Provider business mailing address

2721 VANCE RD
SAINT PARIS OH
43072-9464
US

V. Phone/Fax

Practice location:
  • Phone: 937-902-8231
  • Fax:
Mailing address:
  • Phone: 937-902-8231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.119001-M-IV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.386866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: