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NPI Code Detail

MEDICARE: TIANA NICHOLSON

MEDICARE: TIANA NICHOLSON
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
1106S00000XBehavior TechnicianNC

General Provider Information

NPI Number : 1417882382
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIANA NICHOLSON
Provider Business Mailing Address
First Line : 1304 COZART ST UNIT 106
Second Line :
City : DURHAM
State : NC
Zip : 27704-6218
Country : US
Telephone Number : 973-508-2084
Fax Number :
Provider Business Practice Location Address
First Line : 421 FAYETTEVILLE ST
Second Line :
City : RALEIGH
State : NC
Zip : 27601-1792
Country : US
Telephone Number : 973-508-2084
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2026
Last Update Date : 06/15/2026

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Directions to “ TIANA NICHOLSON ” Practice Location

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