Provider Demographics
NPI:1548417819
Name:NICHOLS, JENNIFER L (FNP-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UTICA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3165
Mailing Address - Country:US
Mailing Address - Phone:315-216-4871
Mailing Address - Fax:315-216-4875
Practice Address - Street 1:101 W UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3165
Practice Address - Country:US
Practice Address - Phone:315-216-4871
Practice Address - Fax:315-216-4875
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2012-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily