Provider Demographics
NPI:1225313331
Name:DEGREG, NICOLE MARIA (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIA
Last Name:DEGREG
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1702 GRAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-1502
Practice Address - Country:US
Practice Address - Phone:513-363-4669
Practice Address - Fax:513-363-4608
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12890-NP363LF0000X
OHRN.345715-COA1163W00000X
TXAP121035363LF0000X
TX809192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse