Provider Demographics
NPI:1265241392
Name:NICHOLS, MARIA (BSN, RN, NCSN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:BSN, RN, NCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13130 STATE HIGHWAY JJ
Mailing Address - Street 2:
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764-7389
Mailing Address - Country:US
Mailing Address - Phone:573-282-0563
Mailing Address - Fax:
Practice Address - Street 1:13130 STATE HIGHWAY JJ
Practice Address - Street 2:
Practice Address - City:MARBLE HILL
Practice Address - State:MO
Practice Address - Zip Code:63764-7389
Practice Address - Country:US
Practice Address - Phone:573-282-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016005210163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse