Provider Demographics
NPI:1639515794
Name:HANCE, NICOLE KRISTIN
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:KRISTIN
Last Name:HANCE
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 1:292 BROOKS MALOTT RD.
Mailing Address - Street 2:
Mailing Address - City:MT. ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154
Mailing Address - Country:US
Mailing Address - Phone:937-444-0035
Mailing Address - Fax:937-444-0036
Practice Address - Street 1:292 BROOKS MALOTT RD.
Practice Address - Street 2:
Practice Address - City:MT. ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154
Practice Address - Country:US
Practice Address - Phone:937-444-0035
Practice Address - Fax:937-444-0036
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14472-NP363LP0200X
OHAPRN.CNP.14472363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics