Provider Demographics
NPI:1194226472
Name:NICHOLS, THERESA (HHA)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5571 E APPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-3071
Mailing Address - Country:US
Mailing Address - Phone:231-728-4353
Mailing Address - Fax:231-728-4370
Practice Address - Street 1:5571 E APPLE AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-3071
Practice Address - Country:US
Practice Address - Phone:231-728-4353
Practice Address - Fax:231-728-4370
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide