MEDICARE: ELIZABETH MARIE NICOLIA

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	175T00000X	Peer Specialist		OH
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1699603241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARIE NICOLIA

Provider Business Mailing Address
First Line	:	507 W FRONT ST APT 3
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-1638
Country	:	US
Telephone Number	:	740-564-2037
Fax Number	:

Provider Business Practice Location Address
First Line	:	507 W FRONT ST APT 3
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-1638
Country	:	US
Telephone Number	:	740-564-2037
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	06/12/2026

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Directions to “ ELIZABETH MARIE NICOLIA ” Practice Location

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