Provider Demographics
NPI:1003015595
Name:MCNICHOLAS, FAITH C M (CPC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:C M
Last Name:MCNICHOLAS
Suffix:
Gender:F
Credentials:CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 682
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-0682
Mailing Address - Country:US
Mailing Address - Phone:847-965-8552
Mailing Address - Fax:847-965-8552
Practice Address - Street 1:5244 W GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-965-8552
Practice Address - Fax:847-965-8552
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other