Provider Demographics
NPI:1013325364
Name:NICHOLS, MINDI (CRNP)
Entity type:Individual
Prefix:MRS
First Name:MINDI
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MINDI
Other - Middle Name:
Other - Last Name:YEICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 GRAMPIAN BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1909
Practice Address - Country:US
Practice Address - Phone:570-320-7691
Practice Address - Fax:570-320-7898
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014100363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner