Provider Demographics
NPI:1508528597
Name:NICHOLSON, TASHEEA T
Entity Type:Individual
Prefix:
First Name:TASHEEA
Middle Name:T
Last Name:NICHOLSON
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 1:55 WILLRY ST FL 1
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2442
Mailing Address - Country:US
Mailing Address - Phone:215-375-2831
Mailing Address - Fax:
Practice Address - Street 1:55 WILLRY ST FL 1
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2442
Practice Address - Country:US
Practice Address - Phone:215-375-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000000Other0