Provider Demographics
NPI:1346644051
Name:FRAVEL, NICCI COLEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:NICCI
Middle Name:COLEEN
Last Name:FRAVEL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:821 WINDING BROOK LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142
Mailing Address - Country:US
Mailing Address - Phone:317-437-2197
Mailing Address - Fax:
Practice Address - Street 1:5026 WEST US 52- CLINIC # 6608
Practice Address - Street 2:MINUTE CLINIC DIAGNOSTICS OF INDIANA
Practice Address - City:NEW PALASTINE
Practice Address - State:IN
Practice Address - Zip Code:43163
Practice Address - Country:US
Practice Address - Phone:317-923-1491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005211A363LF0000X
IN28160960A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily