Provider Demographics
NPI:1639714595
Name:SUGGS, NICOLE BROOKE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:BROOKE
Last Name:SUGGS
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 1:1815 JOLYNN ST NE
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-4077
Mailing Address - Country:US
Mailing Address - Phone:330-209-3800
Mailing Address - Fax:
Practice Address - Street 1:8006 CHABLIS DR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-1917
Practice Address - Country:US
Practice Address - Phone:330-209-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN417096163WM0705X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical