MEDICARE: MRS. TERESA R NICHOLS HCP

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	237700000X	Hearing Instrument Specialist	2101001700	VA

General Provider Information

NPI Number	:	1801304514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA R NICHOLS HCP

Provider Business Mailing Address
First Line	:	2501 COTTONTAIL LN STE 105
Second Line	:
City	:	SOMERSET
State	:	NJ
Zip	:	08873-5125
Country	:	US
Telephone Number	:	732-529-7120
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 WILSON BLVD STE 105
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-3842
Country	:	US
Telephone Number	:	703-525-1898
Fax Number	:

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

Provider Enumeration Date	:	01/16/2018
Last Update Date	:	05/16/2019

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