MEDICARE: NICOLE MARIE KING APRN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	RN.290315-COA1	OH

General Provider Information

NPI Number	:	1144653312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE KING APRN-CNP

Provider Business Mailing Address
First Line	:	570 WHITE POND DR STE 100
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4206
Country	:	US
Telephone Number	:	330-869-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	570 WHITE POND DR STE 100
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4206
Country	:	US
Telephone Number	:	330-869-0124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	02/21/2019

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