Provider Demographics
NPI:1740619261
Name:MORMAN, NICHOLE A (MS, LGC)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:A
Last Name:MORMAN
Suffix:
Gender:F
Credentials:MS, LGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 THOMAS LN
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3902
Mailing Address - Country:US
Mailing Address - Phone:614-566-4363
Mailing Address - Fax:614-566-1928
Practice Address - Street 1:500 THOMAS LN
Practice Address - Street 2:1ST FLOOR
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3902
Practice Address - Country:US
Practice Address - Phone:614-566-4363
Practice Address - Fax:614-566-1928
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH70.000019170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS