Healthcare Provider Details

I. General information

NPI: 1316362825
Provider Name (Legal Business Name): NICOLE JUSTICE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2014
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5329 ANNANDALE CT
WESTERVILLE OH
43082-9282
US

IV. Provider business mailing address

PO BOX 2787
WESTERVILLE OH
43086-2787
US

V. Phone/Fax

Practice location:
  • Phone: 614-736-3035
  • Fax:
Mailing address:
  • Phone: 614-736-3035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: