Provider Demographics
NPI:1760420095
Name:NICHOLS, NANCY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-747-1144
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:820 S MCCLELLAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2457
Practice Address - Country:US
Practice Address - Phone:509-747-1144
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60151885207R00000X
WV22214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVPENDINGMedicare UPIN