Provider Demographics
NPI:1417616962
Name:DUBOSE, NICHOLE R
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:R
Last Name:DUBOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 S THOMAS RD APT 3
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-2123
Mailing Address - Country:US
Mailing Address - Phone:330-285-1096
Mailing Address - Fax:
Practice Address - Street 1:72 S THOMAS RD APT 3
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-2123
Practice Address - Country:US
Practice Address - Phone:330-285-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No251E00000XAgenciesHome Health