Provider Demographics
NPI:1205645694
Name:NICHOLS, DALENE DENEES
Entity type:Individual
Prefix:
First Name:DALENE
Middle Name:DENEES
Last Name:NICHOLS
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 1:8077 GOLD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3120
Mailing Address - Country:US
Mailing Address - Phone:402-812-2665
Mailing Address - Fax:
Practice Address - Street 1:8077 GOLD ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3120
Practice Address - Country:US
Practice Address - Phone:402-812-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372600000XNursing Service Related ProvidersAdult Companion