Provider Demographics
NPI:1518692037
Name:NICHOLS, JOANNA MARIE (LICENSED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LICENSED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 RYANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-8825
Mailing Address - Country:US
Mailing Address - Phone:901-428-7601
Mailing Address - Fax:
Practice Address - Street 1:1324 RYANWOOD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-8825
Practice Address - Country:US
Practice Address - Phone:901-428-7601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58707164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse