Provider Demographics
NPI:1972190452
Name:NICKLEY, AMY CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:NICKLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:CHRISTINE
Other - Last Name:NICKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1903 RED OAK ST
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7787
Mailing Address - Country:US
Mailing Address - Phone:937-248-9417
Mailing Address - Fax:
Practice Address - Street 1:1903 RED OAK ST
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7787
Practice Address - Country:US
Practice Address - Phone:937-248-9417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.356361163WC0400X, 163WH0200X, 163WM0705X, 163WP2201X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care