Provider Demographics
NPI:1568843266
Name:NICHOLL, DIANE E (RN)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:E
Last Name:NICHOLL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 GREAT OAK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1413
Mailing Address - Country:US
Mailing Address - Phone:631-686-5684
Mailing Address - Fax:
Practice Address - Street 1:9 SMITHS LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-3510
Practice Address - Country:US
Practice Address - Phone:631-543-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRN-3256591163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse