MEDICARE: MS. DONNA A NICHOLAS 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	163W00000X	Registered Nurse	59804	SC

General Provider Information

NPI Number	:	1457405169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA A NICHOLAS RN

Provider Business Mailing Address
First Line	:	2715 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-549-8846
Fax Number	:	803-362-8056

Provider Business Practice Location Address
First Line	:	2715 COLONIAL DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6818
Country	:	US
Telephone Number	:	803-635-4689
Fax Number	:	803-635-8056

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/12/2026

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