MEDICARE: NICHOLE WILLIAMS

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	163WC0400X	Case Management Registered Nurse	125598	NC

General Provider Information

NPI Number	:	1669124103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE WILLIAMS

Provider Business Mailing Address
First Line	:	383 VEIN MOUNTAIN RD
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-6802
Country	:	US
Telephone Number	:	704-771-0177
Fax Number	:

Provider Business Practice Location Address
First Line	:	383 VEIN MOUNTAIN RD
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-6802
Country	:	US
Telephone Number	:	704-771-0177
Fax Number	:

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

Provider Enumeration Date	:	01/26/2022
Last Update Date	:	01/26/2022

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Directions to “ NICHOLE WILLIAMS ” Practice Location

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