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NPI Code Detail

MEDICARE: PAULINE T. NICHOL PA-C

MEDICARE: PAULINE T. NICHOL PA-C
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
1363A00000XPhysician AssistantA417SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00234816OTHERSCRAILROAD MEDICARE

General Provider Information

NPI Number : 1255371340
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAULINE T. NICHOL PA-C
Provider Business Mailing Address
First Line : 104 WATER MILL RD
Second Line :
City : GREER
State : SC
Zip : 29650-3622
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 125 COMMONWEALTH DR
Second Line :
City : GREENVILLE
State : SC
Zip : 29615-4812
Country : US
Telephone Number : 864-675-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 07/08/2007

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