Provider Demographics
NPI:1255745709
Name:DRILLING, NICHOLE LOUISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:LOUISE
Last Name:DRILLING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:LOUISE
Other - Last Name:GRUNEISEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5566
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:1000 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-718-4676
Practice Address - Fax:317-718-2476
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001658A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant