Provider Demographics
NPI:1013956366
Name:NICHOLS, KATHERINE M (APRN)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 SWANTOWN HL
Mailing Address - Street 2:STONINGTON INSITUTE
Mailing Address - City:NORTH STONINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06359-1022
Mailing Address - Country:US
Mailing Address - Phone:860-535-1010
Mailing Address - Fax:860-535-9076
Practice Address - Street 1:75 SWANTOWN HL
Practice Address - Street 2:STONINGTON INSTITUTE
Practice Address - City:NORTH STONINGTON
Practice Address - State:CT
Practice Address - Zip Code:06359-1022
Practice Address - Country:US
Practice Address - Phone:860-535-1010
Practice Address - Fax:860-535-9076
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5939364SP0809X
MARN195393364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANS0681Medicare PIN
CTNS0681Medicare PIN