Provider Demographics
NPI:1134863459
Name:NICKLES, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:NICKLES
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 1:702 N SAWYER RD
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2532
Mailing Address - Country:US
Mailing Address - Phone:260-347-3333
Mailing Address - Fax:260-347-3303
Practice Address - Street 1:702 N SAWYER RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2532
Practice Address - Country:US
Practice Address - Phone:260-347-3333
Practice Address - Fax:260-347-3303
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27076534A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse