MEDICARE: DIANNE ELIZABETH NICHOLAS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1942410147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE ELIZABETH NICHOLAS

Provider Business Mailing Address
First Line	:	970 PETIT AVE STE C
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-2215
Country	:	US
Telephone Number	:	805-443-2343
Fax Number	:	805-650-9529

Provider Business Practice Location Address
First Line	:	970 PETIT AVE STE C
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93004-2215
Country	:	US
Telephone Number	:	805-443-2343
Fax Number	:	805-650-9529

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/21/2022

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