MEDICARE: DALENE DENEES NICHOLS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	311ZA0620X	Adult Care Home Facility
2	372600000X	Adult Companion
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1205645694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALENE DENEES NICHOLS

Provider Business Mailing Address
First Line	:	8077 GOLD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3120
Country	:	US
Telephone Number	:	402-812-2665
Fax Number	:

Provider Business Practice Location Address
First Line	:	8077 GOLD ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-3120
Country	:	US
Telephone Number	:	402-812-2665
Fax Number	:

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

Provider Enumeration Date	:	12/31/2024
Last Update Date	:	12/31/2024

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Directions to “ DALENE DENEES NICHOLS ” Practice Location

Language	Start Address	Practice Location

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