Provider Demographics
NPI:1164569760
Name:NICHOLS, BETTY (RN)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17230 NOOPIMING DR.
Mailing Address - Street 2:
Mailing Address - City:ONAIMA
Mailing Address - State:MN
Mailing Address - Zip Code:56359
Mailing Address - Country:US
Mailing Address - Phone:310-532-7511
Mailing Address - Fax:320-532-7524
Practice Address - Street 1:17230 NOOPIMING DR.
Practice Address - Street 2:
Practice Address - City:ONAIMA
Practice Address - State:MN
Practice Address - Zip Code:56359
Practice Address - Country:US
Practice Address - Phone:310-532-7511
Practice Address - Fax:320-532-7524
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 111515-6163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse