Provider Demographics
NPI:1770854127
Name:NICHOLAS, PHYLLIS CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:CHRISTINE
Last Name:NICHOLAS
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 1:659 ABREGO ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3238
Mailing Address - Country:US
Mailing Address - Phone:831-717-4991
Mailing Address - Fax:831-717-4996
Practice Address - Street 1:659 ABREGO ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3238
Practice Address - Country:US
Practice Address - Phone:831-717-4991
Practice Address - Fax:831-717-4996
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA351225163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health