MEDICARE: ELENA NIKOLOVA

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	164W00000X	Licensed Practical Nurse	PN.135687	OH

General Provider Information

NPI Number	:	1508306879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA NIKOLOVA

Provider Business Mailing Address
First Line	:	6958 QUEENSWAY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2134
Country	:	US
Telephone Number	:	513-213-2427
Fax Number	:

Provider Business Practice Location Address
First Line	:	6958 QUEENSWAY LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45230-2134
Country	:	US
Telephone Number	:	513-213-2427
Fax Number	:

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

Provider Enumeration Date	:	03/06/2017
Last Update Date	:	03/06/2017

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