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General NPI Number Information
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NPI Number | 1073264297
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Entity Type | Individual
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Provider Name | MICHAEL PAUL NICKELL NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 15708 MCCONNELLSVILLE RD
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City | CALDWELL
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State | OH
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Zip | 43724-9678
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Country | US
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Telephone | 740-305-1312
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Fax |
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Provider Business Mailing Address
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Address Line | 622 E CROSS ST
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City | SUMMERFIELD
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State | OH
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Zip | 43788-9516
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Country | US
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Telephone | 740-995-3852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN.431204
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0031075
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License Number State | OH
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