Provider Demographics
NPI:1669678710
Name:MCBRIDE, NICOLE ANGELIQUE (RN)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANGELIQUE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17426 ELDAMERE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1710
Mailing Address - Country:US
Mailing Address - Phone:216-816-4074
Mailing Address - Fax:
Practice Address - Street 1:17426 ELDAMERE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-1710
Practice Address - Country:US
Practice Address - Phone:216-816-4074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.454978163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management