Provider Demographics
NPI:1568805547
Name:NICHOLS, RACHEL ELAYNE (LPN)
Entity Type:Individual
Prefix:MS
First Name:RACHEL
Middle Name:ELAYNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 COUNTY ROAD 24
Mailing Address - Street 2:
Mailing Address - City:CARDINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43315-9320
Mailing Address - Country:US
Mailing Address - Phone:330-697-3395
Mailing Address - Fax:
Practice Address - Street 1:3450 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:CARDINGTON
Practice Address - State:OH
Practice Address - Zip Code:43315-9320
Practice Address - Country:US
Practice Address - Phone:330-697-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.142304-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse