Provider Demographics
NPI:1942410147
Name:NICHOLAS, DIANNE ELIZABETH
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:ELIZABETH
Last Name:NICHOLAS
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 1:970 PETIT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2215
Mailing Address - Country:US
Mailing Address - Phone:805-443-2343
Mailing Address - Fax:805-650-9529
Practice Address - Street 1:970 PETIT AVE STE C
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-2215
Practice Address - Country:US
Practice Address - Phone:805-443-2343
Practice Address - Fax:805-650-9529
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator