Provider Demographics
NPI:1306385612
Name:NICHOLSON, ALICE
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:NICHOLSON
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:PO BOX 744
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-0744
Mailing Address - Country:US
Mailing Address - Phone:866-878-6747
Mailing Address - Fax:866-878-6747
Practice Address - Street 1:315 2ND AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2418
Practice Address - Country:US
Practice Address - Phone:866-878-6747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide