MEDICARE: MRS. NICOLE J KLINEDINST RN

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	163WC1500X	Community Health Registered Nurse	RN166868	GA

General Provider Information

NPI Number	:	1275745341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE J KLINEDINST RN

Provider Business Mailing Address
First Line	:	705 HIGHLAND SQUARE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30306-2291
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 CLIFTON RD NE
Second Line	:	SUITE 244
City	:	ATLANTA
State	:	GA
Zip	:	30322-4201
Country	:	US
Telephone Number	:	404-683-7234
Fax Number	:

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

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	07/08/2007

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