Provider Demographics
NPI:1134724529
Name:NICKLER, DIANE
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:NICKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 N WATER ST APT 207
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-1185
Mailing Address - Country:US
Mailing Address - Phone:419-443-1011
Mailing Address - Fax:
Practice Address - Street 1:843 N WATER ST APT 207
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-1185
Practice Address - Country:US
Practice Address - Phone:419-443-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7401483Medicaid