Provider Demographics
NPI:1134746340
Name:NICHOLSON, CYNTHIA MAGAN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MAGAN
Last Name:NICHOLSON
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 1:1033 EMILY LN
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:TX
Mailing Address - Zip Code:75773-1927
Mailing Address - Country:US
Mailing Address - Phone:903-638-4573
Mailing Address - Fax:
Practice Address - Street 1:1033 EMILY LN
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:TX
Practice Address - Zip Code:75773-1927
Practice Address - Country:US
Practice Address - Phone:903-638-4573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX345465164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse