Provider Demographics
NPI:1689027013
Name:NICOLAI, CODY ALLEN (RN)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:ALLEN
Last Name:NICOLAI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SOURWOOD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-7989
Mailing Address - Country:US
Mailing Address - Phone:302-535-9384
Mailing Address - Fax:
Practice Address - Street 1:1035 SOURWOOD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-7989
Practice Address - Country:US
Practice Address - Phone:302-535-9384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0044460163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse