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NPI Code Detail

MEDICARE: AYANA NICHOLES

MEDICARE: AYANA NICHOLES
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 TechnicianRBT-26-506962IL

General Provider Information

NPI Number : 1740113711
Entity Type Code : Individual
Provider Name (Legal Business Name) : AYANA NICHOLES
Provider Business Mailing Address
First Line : 7228 CIRCLE AVE
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-1163
Country : US
Telephone Number : 630-632-4350
Fax Number :
Provider Business Practice Location Address
First Line : 7228 CIRCLE AVE
Second Line :
City : FOREST PARK
State : IL
Zip : 60130-1163
Country : US
Telephone Number : 630-632-4350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2026
Last Update Date : 06/08/2026

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Directions to “ AYANA NICHOLES ” Practice Location

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