Provider Demographics
NPI:1396023271
Name:NICHOLAS, IRMA I (LPN)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:I
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 JULIAN PL
Mailing Address - Street 2:PMB944
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-3419
Mailing Address - Country:US
Mailing Address - Phone:315-876-8519
Mailing Address - Fax:
Practice Address - Street 1:118 JULIAN PL
Practice Address - Street 2:PMB944
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-3419
Practice Address - Country:US
Practice Address - Phone:315-876-8519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249440164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse