Provider Demographics
NPI:1497334452
Name:CASS, NICOLE LYNN (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:LYNN
Last Name:CASS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:LYNN
Other - Last Name:NORDHAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:13580 ROAD 14L
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9769
Mailing Address - Country:US
Mailing Address - Phone:419-204-1242
Mailing Address - Fax:
Practice Address - Street 1:305 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1725
Practice Address - Country:US
Practice Address - Phone:419-523-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.411995163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse