Provider Demographics
NPI:1487838694
Name:NORVELL, NICHOLE MARIE (FNP)
Entity Type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:MARIE
Last Name:NORVELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 WETZEL FARM RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45315-8984
Mailing Address - Country:US
Mailing Address - Phone:937-416-4186
Mailing Address - Fax:937-264-3159
Practice Address - Street 1:1149 EXPERIMENT FARM RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-1071
Practice Address - Country:US
Practice Address - Phone:937-540-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.283085163W00000X
OHAPRN.CNP.022614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2182641Medicaid