Provider Demographics
NPI:1891268702
Name:NICHOLS, JANEIL F
Entity Type:Individual
Prefix:MISS
First Name:JANEIL
Middle Name:F
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JANEIL
Other - Middle Name:F
Other - Last Name:RUNYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 ALVARADO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-5104
Mailing Address - Country:US
Mailing Address - Phone:505-219-8701
Mailing Address - Fax:
Practice Address - Street 1:5601 DOMINGO RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-1610
Practice Address - Country:US
Practice Address - Phone:505-268-5295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker