Provider Demographics
NPI:1629336292
Name:NICHOLS, SHALEEN (CNA)
Entity Type:Individual
Prefix:
First Name:SHALEEN
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2787 S KEY BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6076
Mailing Address - Country:US
Mailing Address - Phone:602-919-1700
Mailing Address - Fax:
Practice Address - Street 1:2787 S KEY BISCAYNE DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6076
Practice Address - Country:US
Practice Address - Phone:602-919-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCNA464099033376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide