Provider Demographics
NPI:1568478501
Name:OLDFIELD, NIKKOLE JEAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NIKKOLE
Middle Name:JEAN
Last Name:OLDFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:NIKKOLE
Other - Middle Name:JEAN
Other - Last Name:CECERE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1386 JOHNSONS RUN RD
Mailing Address - Street 2:
Mailing Address - City:STOUT
Mailing Address - State:OH
Mailing Address - Zip Code:45684
Mailing Address - Country:US
Mailing Address - Phone:937-544-9759
Mailing Address - Fax:937-544-7989
Practice Address - Street 1:1143 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693
Practice Address - Country:US
Practice Address - Phone:937-544-1620
Practice Address - Fax:937-544-1620
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN060883164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2344378OtherINDEPENDANT PROVIDER NUMB