Provider Demographics
NPI:1205545019
Name:BURICK, NICKOLAS PAUL
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:PAUL
Last Name:BURICK
Suffix:
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 1:116 OHIO ST
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:OH
Mailing Address - Zip Code:44254-1048
Mailing Address - Country:US
Mailing Address - Phone:330-691-9187
Mailing Address - Fax:
Practice Address - Street 1:116 OHIO ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:OH
Practice Address - Zip Code:44254-1048
Practice Address - Country:US
Practice Address - Phone:330-691-9187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 376J00000X
OH3726000000X372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion