Provider Demographics
NPI:1790905149
Name:ENGELMANN, NICHOLE JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:JEAN
Last Name:ENGELMANN
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 1:3488 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CONNEAUT
Mailing Address - State:OH
Mailing Address - Zip Code:44030-3334
Mailing Address - Country:US
Mailing Address - Phone:440-224-1385
Mailing Address - Fax:
Practice Address - Street 1:3520 E CENTER ST
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030-3332
Practice Address - Country:US
Practice Address - Phone:440-224-7433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN309478163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2512070Medicaid