=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164283081
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAWNYA MAE NICHOLS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2024
-----------------------------------------------------
Last Update Date | 01/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 RHODES AVE APT 23
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44302-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-907-3820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18592 EDWARDS RD LOT 215
-----------------------------------------------------
City | DOYLESTOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44230-9565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-907-3820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------