Provider Demographics
NPI:1578872610
Name:NICHOLS, FAITH ANN (RN)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ANN
Last Name:NICHOLS
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 1:612 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:YOAKUM
Mailing Address - State:TX
Mailing Address - Zip Code:77995-2622
Mailing Address - Country:US
Mailing Address - Phone:361-293-5795
Mailing Address - Fax:361-293-5798
Practice Address - Street 1:612 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:YOAKUM
Practice Address - State:TX
Practice Address - Zip Code:77995-2622
Practice Address - Country:US
Practice Address - Phone:361-293-5795
Practice Address - Fax:361-293-5798
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX012245251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679671Medicare Oscar/Certification