Provider Demographics
NPI:1497817506
Name:NICHOLS, CARRIE BEINER (MSW INTERN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:BEINER
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 HOSP WAY APT 237
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1232
Mailing Address - Country:US
Mailing Address - Phone:760-214-3866
Mailing Address - Fax:
Practice Address - Street 1:240 S HICKORY ST # 210
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4355
Practice Address - Country:US
Practice Address - Phone:760-747-0205
Practice Address - Fax:760-747-0582
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9849OtherMEDICAL PROVIDER NUMBER