Provider Demographics
NPI:1992003602
Name:NICHOLS, LAURA (LM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17921 MOON HILL CT
Mailing Address - Street 2:
Mailing Address - City:HIDDEN VALLEY LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95467-8097
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17921 MOON HILL CT
Practice Address - Street 2:
Practice Address - City:HIDDEN VALLEY LAKE
Practice Address - State:CA
Practice Address - Zip Code:95467-8097
Practice Address - Country:US
Practice Address - Phone:707-350-0236
Practice Address - Fax:707-987-3166
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM293176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife