Provider Demographics
NPI:1104040906
Name:NOWELL, NICOLE K (RN, BSN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:NOWELL
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 HOMESTEAD DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-4629
Mailing Address - Country:US
Mailing Address - Phone:678-363-8338
Mailing Address - Fax:
Practice Address - Street 1:358 HOMESTEAD DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-4629
Practice Address - Country:US
Practice Address - Phone:678-363-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator