Provider Demographics
NPI:1063819183
Name:NICHOLSON, ALEXANDRIA (CNIM)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:ALEXABDRIA
Other - Middle Name:
Other - Last Name:BENBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16608 VALDERAMA WAY
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13401 RAILWAY DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-2272
Practice Address - Country:US
Practice Address - Phone:405-841-7826
Practice Address - Fax:405-841-7827
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other