Provider Demographics
NPI:1235899246
Name:NICHOLS, LAURA ANN
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13881 POWELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:OH
Mailing Address - Zip Code:43451-9769
Mailing Address - Country:US
Mailing Address - Phone:419-619-4157
Mailing Address - Fax:
Practice Address - Street 1:13881 POWELL RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:OH
Practice Address - Zip Code:43451-9769
Practice Address - Country:US
Practice Address - Phone:419-619-4157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker