Provider Demographics
NPI:1790400265
Name:NICHOLS, BROOKE ANNE (CNA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:RUFFIN
Mailing Address - State:SC
Mailing Address - Zip Code:29475-3967
Mailing Address - Country:US
Mailing Address - Phone:843-635-0083
Mailing Address - Fax:
Practice Address - Street 1:2233 BETHEL RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:SC
Practice Address - Zip Code:29475-3967
Practice Address - Country:US
Practice Address - Phone:843-635-0083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC558222376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide