MEDICARE: VERONICA JEAN NICHOLSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	106S00000X	Behavior Technician
2	225400000X	Rehabilitation Practitioner
3	374J00000X	Doula

General Provider Information

NPI Number	:	1760782551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA JEAN NICHOLSON

Provider Business Mailing Address
First Line	:	2300 ROCK SPRINGS DR APT 2030
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3149
Country	:	US
Telephone Number	:	702-812-2374
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 ROCK SPRINGS DR APT 2030
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3149
Country	:	US
Telephone Number	:	702-812-2374
Fax Number	:

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	08/21/2023

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