Provider Demographics
NPI:1477505295
Name:NICHOLS, DENISE E (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 COUNTY ROAD 365
Mailing Address - Street 2:
Mailing Address - City:CRANE HILL
Mailing Address - State:AL
Mailing Address - Zip Code:35053-4038
Mailing Address - Country:US
Mailing Address - Phone:256-590-3613
Mailing Address - Fax:256-747-2262
Practice Address - Street 1:1465 COUNTY ROAD 365
Practice Address - Street 2:
Practice Address - City:CRANE HILL
Practice Address - State:AL
Practice Address - Zip Code:35053-4038
Practice Address - Country:US
Practice Address - Phone:256-590-3613
Practice Address - Fax:256-747-2262
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9204451367500000X
AL1-071048367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306034900Medicaid
P00197074OtherPALMETTO GBA-RR MEDICARE
AL009931961Medicaid
FLG3398OtherBCBS
AL59200186OtherBCBS
AL59200187OtherBCBS
FL306034900Medicaid
FL306034900Medicaid