Provider Demographics
NPI:1518017060
Name:NICHOLS, DEBRA J (PNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
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Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5645
Practice Address - Country:US
Practice Address - Phone:207-743-8766
Practice Address - Fax:207-743-1579
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNP81672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME252320099Medicaid