Provider Demographics
NPI:1750829727
Name:YARBROUGH, NICHOLE (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:YARBROUGH
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 1:622 S 22ND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2757
Mailing Address - Country:US
Mailing Address - Phone:502-376-6141
Mailing Address - Fax:
Practice Address - Street 1:622 S 22ND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2757
Practice Address - Country:US
Practice Address - Phone:502-376-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH415553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse