Provider Demographics
NPI:1053654541
Name:NICHOLS, CHLOE (NP)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-3409
Mailing Address - Country:US
Mailing Address - Phone:240-566-6161
Mailing Address - Fax:
Practice Address - Street 1:201 THOMAS JOHNSON DR STE 104
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4302
Practice Address - Country:US
Practice Address - Phone:240-566-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR181711363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner