Provider Demographics
NPI:1851699789
Name:NORRIS, NICOLE L (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:621 KELLY BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-8523
Mailing Address - Country:US
Mailing Address - Phone:724-794-4009
Mailing Address - Fax:724-794-4099
Practice Address - Street 1:621 KELLY BLVD
Practice Address - Street 2:
Practice Address - City:SLIPPERY ROCK
Practice Address - State:PA
Practice Address - Zip Code:16057-8523
Practice Address - Country:US
Practice Address - Phone:724-794-4009
Practice Address - Fax:724-794-4099
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06968363A00000X
PAMA064143363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB125720Medicare PIN
TXTXB125719Medicare PIN
TXTXB125714Medicare PIN