Basic Information
| Provider Information | |||||||||
| NPI: | 1417394941 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | C-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 925 TRAILWOOD DR | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445125008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307587575 | ||||||||
| FaxNumber: | 3307581833 | ||||||||
| Practice Location | |||||||||
| Address1: | 925 TRAILWOOD DR | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445125008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307587575 | ||||||||
| FaxNumber: | 3307581833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2013 | ||||||||
| LastUpdateDate: | 05/23/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | COA.14412-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.