Provider Demographics
NPI:1760845531
Name:NICHOLSON, ANGELA (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-4852
Mailing Address - Country:US
Mailing Address - Phone:304-529-7004
Mailing Address - Fax:304-529-7303
Practice Address - Street 1:528 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-4852
Practice Address - Country:US
Practice Address - Phone:304-529-7004
Practice Address - Fax:304-529-7303
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV61249363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily