Provider Demographics
NPI:1578194767
Name:NICHOLS, LAURAN BETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAURAN
Middle Name:BETTE
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 1:3839 E STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-9618
Mailing Address - Country:US
Mailing Address - Phone:765-366-8217
Mailing Address - Fax:
Practice Address - Street 1:1720 LAFAYETTE RD STE A
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-4603
Practice Address - Country:US
Practice Address - Phone:765-323-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009693A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily