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General NPI Number Information
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NPI Number | 1972501138
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Entity Type | Individual
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Provider Name | HEIDI NICHOLS CNP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2005
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Last Update Date | 06/21/2011
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Provider Practice Location Address
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Address Line | 777 KIMOLE LN
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City | ADRIAN
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State | MI
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Zip | 49221-1478
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Country | US
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Telephone | 517-263-3393
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Fax |
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Provider Business Mailing Address
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Address Line | 4235 SECOR RD
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City | TOLEDO
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State | OH
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Zip | 43623-4231
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Country | US
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Telephone | 419-479-5605
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704140375
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License Number State | MI
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