MEDICARE: NURSE NICOLE'S HOME CARE, LLC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1972266203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NURSE NICOLE'S HOME CARE, LLC

Provider Business Mailing Address
First Line	:	2545 BELLWOOD RD STE 105
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-4481
Country	:	US
Telephone Number	:	804-731-4590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2545 BELLWOOD RD STE 105
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23237-4481
Country	:	US
Telephone Number	:	804-731-4590
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. NICOLE MICHELLE BROWN
Credential	:	REGISTERED NURSE
Telephone Number	:	804-731-4590

Provider Enumeration Date	:	10/13/2021
Last Update Date	:	10/13/2021

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