Provider Demographics
NPI:1316534274
Name:NICHOLAS, MARSHA RACHEL (LVN)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:RACHEL
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:RACHEL
Other - Last Name:NICHOLAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:5170 1/2 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-1339
Mailing Address - Country:US
Mailing Address - Phone:323-835-3564
Mailing Address - Fax:
Practice Address - Street 1:5170 1/2 W 20TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-1339
Practice Address - Country:US
Practice Address - Phone:323-835-3564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207774164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse