Provider Demographics
NPI:1508557489
Name:NICHOLS, PAIGE OLIVIA
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:OLIVIA
Last Name:NICHOLS
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 1:1728 E 1ST ST APT 6
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1720
Mailing Address - Country:US
Mailing Address - Phone:608-279-9487
Mailing Address - Fax:
Practice Address - Street 1:1201 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2424
Practice Address - Country:US
Practice Address - Phone:608-279-9487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians