MEDICARE: NICHOLE PETE

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	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1194688903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE PETE

Provider Business Mailing Address
First Line	:	5902 2ND PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2208
Country	:	US
Telephone Number	:	206-488-4906
Fax Number	:

Provider Business Practice Location Address
First Line	:	5902 2ND PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2208
Country	:	US
Telephone Number	:	206-488-4906
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “ NICHOLE PETE ” Practice Location

Language	Start Address	Practice Location

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