MEDICARE: LORRAINE NICHOLS D.O.

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	207Q00000X	Family Medicine Physician	0530777	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396748745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORRAINE NICHOLS D.O.

Provider Business Mailing Address
First Line	:	1220 BILTMORE DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-1995
Country	:	US
Telephone Number	:	785-331-1700
Fax Number	:	785-331-1799

Provider Business Practice Location Address
First Line	:	1220 BILTMORE DR
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-1995
Country	:	US
Telephone Number	:	785-505-2626
Fax Number	:	785-505-5333

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/02/2021

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