Provider Demographics
NPI:1043007222
Name:NICHOLS, CALLIE MARIE
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:MARIE
Last Name:NICHOLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W 15TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-7608
Mailing Address - Country:US
Mailing Address - Phone:785-864-4720
Mailing Address - Fax:
Practice Address - Street 1:1535 W 15TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-7608
Practice Address - Country:US
Practice Address - Phone:785-864-4720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program