Provider Demographics
NPI:1508632589
Name:NICK, DONNA L
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:L
Last Name:NICK
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 1:7411 PALMLEAF LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4211
Mailing Address - Country:US
Mailing Address - Phone:614-668-6365
Mailing Address - Fax:
Practice Address - Street 1:7411 PALMLEAF LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4211
Practice Address - Country:US
Practice Address - Phone:614-668-6365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care