Provider Demographics
NPI:1760103006
Name:NICHOLS, MARICHU BERRO (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:
First Name:MARICHU
Middle Name:BERRO
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24795 PINEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20152-4239
Mailing Address - Country:US
Mailing Address - Phone:703-542-7691
Mailing Address - Fax:
Practice Address - Street 1:24795 PINEBROOK RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4239
Practice Address - Country:US
Practice Address - Phone:703-542-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184984363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily