Healthcare Provider Details

I. General information

NPI: 1396667812
Provider Name (Legal Business Name): MAHOGANY NICHOLSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4416 AIRPORT HWY APT 39
TOLEDO OH
43615-7089
US

IV. Provider business mailing address

4416 AIRPORT HWY APT 39
TOLEDO OH
43615-7089
US

V. Phone/Fax

Practice location:
  • Phone: 567-420-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number185286
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: