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General NPI Number Information
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NPI Number | 1518017060
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Entity Type | Individual
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Provider Name | DEBRA J NICHOLS PNP
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 193 MAIN ST SUITE 9
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City | NORWAY
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State | ME
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Zip | 04268-5645
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Country | US
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Telephone | 207-743-8766
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Fax | 207-743-1579
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP81672
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License Number State | ME
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