Provider Demographics
NPI:1922720960
Name:THOMAS, NICHOLE MARIE
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:MARIE
Other - Last Name:DICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:316 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:50058-1302
Mailing Address - Country:US
Mailing Address - Phone:712-790-6425
Mailing Address - Fax:
Practice Address - Street 1:316 2ND AVE
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:50058-1302
Practice Address - Country:US
Practice Address - Phone:712-790-6425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA155566163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse