Provider Demographics
NPI:1245680156
Name:CASSIE NICHOLS
Entity type:Organization
Organization Name:CASSIE NICHOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-526-3601
Mailing Address - Street 1:50359 DOVER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN PT
Mailing Address - State:OH
Mailing Address - Zip Code:43942-9744
Mailing Address - Country:US
Mailing Address - Phone:740-526-3601
Mailing Address - Fax:
Practice Address - Street 1:50359 DOVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:POWHATAN PT
Practice Address - State:OH
Practice Address - Zip Code:43942-9744
Practice Address - Country:US
Practice Address - Phone:740-526-3601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.124740-MEDS251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care