Provider Demographics
NPI:1821073081
Name:NICKOLAUS, JANET (PMHNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:NICKOLAUS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4332
Mailing Address - Country:US
Mailing Address - Phone:360-901-0170
Mailing Address - Fax:360-254-3552
Practice Address - Street 1:2300 E MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4332
Practice Address - Country:US
Practice Address - Phone:360-901-0170
Practice Address - Fax:360-254-3552
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004009363LP0808X
OR000039125N6 PMHNP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health