Provider Demographics
NPI:1265890842
Name:NICHOL, JOANN L (LPN)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:L
Last Name:NICHOL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:CARSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48419-9109
Mailing Address - Country:US
Mailing Address - Phone:810-627-1726
Mailing Address - Fax:
Practice Address - Street 1:211 S CHURCH RD
Practice Address - Street 2:
Practice Address - City:CARSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48419-9109
Practice Address - Country:US
Practice Address - Phone:810-627-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703080248164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse