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General NPI Number Information
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NPI Number | 1679553499
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Entity Type | Individual
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Provider Name | DIANNE NICHOLAS M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 5160 TIMBER CREEK DR
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City | HOUSTON
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State | TX
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Zip | 77017-5968
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Country | US
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Telephone | 713-440-0602
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Fax | 713-944-8903
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Provider Business Mailing Address
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Address Line | PO BOX 14231
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City | HOUSTON
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State | TX
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Zip | 77221-4231
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Country | US
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Telephone | 713-440-0602
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Fax | 713-944-8903
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | J2238
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J2238
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License Number State | TX
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