Provider Demographics
NPI:1205539772
Name:NICHOLS, ROBERT LEE III
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:NICHOLS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 E 130TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-3005
Mailing Address - Country:US
Mailing Address - Phone:216-681-3734
Mailing Address - Fax:
Practice Address - Street 1:3033 E 130TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-3005
Practice Address - Country:US
Practice Address - Phone:216-681-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant