Provider Demographics
NPI:1093763963
Name:NICHOLSON, DONNA L (APN)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:L
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 ASHBY ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5100
Mailing Address - Country:US
Mailing Address - Phone:830-372-0600
Mailing Address - Fax:830-372-0602
Practice Address - Street 1:1255 ASHBY ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5100
Practice Address - Country:US
Practice Address - Phone:830-372-0600
Practice Address - Fax:830-372-0602
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518293363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152079301Medicaid
TX152079301Medicaid
TXS99564Medicare UPIN