Healthcare Provider Details

I. General information

NPI: 1275061871
Provider Name (Legal Business Name): CAROLYN MARIE NICHOIS RN, CRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 W BRONCO DR
MERKEL TX
79536-4326
US

IV. Provider business mailing address

296 W BRONCO DR
MERKEL TX
79536-4326
US

V. Phone/Fax

Practice location:
  • Phone: 325-665-0424
  • Fax:
Mailing address:
  • Phone: 325-665-0424
  • Fax: 325-928-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number541115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: