Provider Demographics
NPI:1235333907
Name:HORN, NICOLE D (DPM)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:HORN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1033
Mailing Address - Country:US
Mailing Address - Phone:330-473-1447
Mailing Address - Fax:330-473-1520
Practice Address - Street 1:890 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1033
Practice Address - Country:US
Practice Address - Phone:330-473-1447
Practice Address - Fax:330-473-1520
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003427213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2783439Medicaid
OHHO4210841Medicare PIN
OHHO4210842Medicare PIN