Provider Demographics
NPI:1023545415
Name:NICHOLSON, ROBERTA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:JEAN
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:KALTENBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1179 TIRE HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-7708
Mailing Address - Country:US
Mailing Address - Phone:814-242-5738
Mailing Address - Fax:814-242-5738
Practice Address - Street 1:424 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-1462
Practice Address - Country:US
Practice Address - Phone:302-645-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2017-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0037414163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse