Provider Demographics
NPI:1619628906
Name:PICTON, NICOLLE C (RN)
Entity Type:Individual
Prefix:
First Name:NICOLLE
Middle Name:C
Last Name:PICTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:NICOLLE
Other - Middle Name:C
Other - Last Name:LARKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1773 REGENT AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2221
Mailing Address - Country:US
Mailing Address - Phone:530-338-1745
Mailing Address - Fax:
Practice Address - Street 1:1773 REGENT AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2221
Practice Address - Country:US
Practice Address - Phone:153-033-8174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA842688163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty