MEDICARE: NICKI NICOLE HOLIDAY 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	163WA2000X	Administrator Registered Nurse	202076038	TX

General Provider Information

NPI Number	:	1285885665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICKI NICOLE HOLIDAY RN

Provider Business Mailing Address
First Line	:	5433 MELANITE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3226
Country	:	US
Telephone Number	:	281-438-9200
Fax Number	:	281-439-9202

Provider Business Practice Location Address
First Line	:	5433 MELANITE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3226
Country	:	US
Telephone Number	:	281-438-9200
Fax Number	:	281-439-9202

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

Provider Enumeration Date	:	10/03/2008
Last Update Date	:	10/03/2008

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