Provider Demographics
NPI:1073264297
Name:NICKELL, MICHAEL PAUL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:NICKELL
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:622 E CROSS ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:43788-9516
Mailing Address - Country:US
Mailing Address - Phone:740-995-3852
Mailing Address - Fax:
Practice Address - Street 1:15708 MCCONNELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9678
Practice Address - Country:US
Practice Address - Phone:740-305-1312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.431204163WG0000X
OHAPRN.CNP.0031075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice