Provider Demographics
NPI:1629664339
Name:NICELY, ALISON COLLEEN
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:COLLEEN
Last Name:NICELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13945 E WILLARD RD
Mailing Address - Street 2:
Mailing Address - City:NOVELTY
Mailing Address - State:OH
Mailing Address - Zip Code:44072-9734
Mailing Address - Country:US
Mailing Address - Phone:440-537-2742
Mailing Address - Fax:
Practice Address - Street 1:13945 E WILLARD RD
Practice Address - Street 2:
Practice Address - City:NOVELTY
Practice Address - State:OH
Practice Address - Zip Code:44072-9734
Practice Address - Country:US
Practice Address - Phone:440-537-2742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide