Provider Demographics
NPI:1962482182
Name:NICHOLS, ELAINE E (RN, CNS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3957 BURGUNDY BAY BLVD W
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8278
Mailing Address - Country:US
Mailing Address - Phone:330-618-2573
Mailing Address - Fax:
Practice Address - Street 1:3957 BURGUNDY BAY BLVD W
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-8278
Practice Address - Country:US
Practice Address - Phone:330-618-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN092242163W00000X
OHNS04474364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist