Provider Demographics
NPI:1326727629
Name:MUCHISON, NICHOLE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:L
Last Name:MUCHISON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 MYERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7825
Mailing Address - Country:US
Mailing Address - Phone:912-602-1142
Mailing Address - Fax:
Practice Address - Street 1:1600 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-6737
Practice Address - Country:US
Practice Address - Phone:912-289-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN262700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily