Provider Demographics
NPI:1699007492
Name:PEOPLES, NICHOLE DIANE (RN, BSN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:DIANE
Last Name:PEOPLES
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S. FIFTH STREET
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5832
Mailing Address - Country:US
Mailing Address - Phone:580-249-3437
Mailing Address - Fax:580-249-5857
Practice Address - Street 1:305 S. FIFTH STREET
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5832
Practice Address - Country:US
Practice Address - Phone:580-249-3437
Practice Address - Fax:580-249-5857
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK75174163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant