MEDICARE: JENNA NICHOLS MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1215515481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA NICHOLS MD

Provider Business Mailing Address
First Line	:	7121 EUCLID AVE
Second Line	:
City	:	MADEIRA
State	:	OH
Zip	:	45243-2543
Country	:	US
Telephone Number	:	408-438-3474
Fax Number	:

Provider Business Practice Location Address
First Line	:	4777 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2725
Country	:	US
Telephone Number	:	513-686-3000
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	01/06/2026

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