Provider Demographics
NPI:1376816892
Name:NICHOLS, REBECCA LYNN (CHAP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CHAP
Other - Prefix:MS
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHAP
Mailing Address - Street 1:712 OCEAN CAPE ROAD
Mailing Address - Street 2:
Mailing Address - City:YAKUTAT
Mailing Address - State:AK
Mailing Address - Zip Code:99689-0112
Mailing Address - Country:US
Mailing Address - Phone:907-784-3275
Mailing Address - Fax:907-784-3263
Practice Address - Street 1:712 OCEAN CAPE ROAD
Practice Address - Street 2:
Practice Address - City:YAKUTAT
Practice Address - State:AK
Practice Address - Zip Code:99689-0112
Practice Address - Country:US
Practice Address - Phone:907-784-3275
Practice Address - Fax:907-784-3263
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker