Provider Demographics
NPI:1255933180
Name:OPLIE, NIKKI
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:OPLIE
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 1:123 MJR RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706
Mailing Address - Country:US
Mailing Address - Phone:254-744-7658
Mailing Address - Fax:
Practice Address - Street 1:123 MJR RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706
Practice Address - Country:US
Practice Address - Phone:254-744-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770926163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse