Provider Demographics
NPI:1811011851
Name:NICHOLS, TAMMALA J
Entity Type:Individual
Prefix:
First Name:TAMMALA
Middle Name:J
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-2919
Mailing Address - Country:US
Mailing Address - Phone:440-396-5407
Mailing Address - Fax:
Practice Address - Street 1:107 MAPLE ST
Practice Address - Street 2:
Practice Address - City:SOUTH AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-2919
Practice Address - Country:US
Practice Address - Phone:440-396-5407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other