Provider Demographics
NPI:1295087906
Name:BACK, NICOLE SCHNABEL (ANP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:SCHNABEL
Last Name:BACK
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1666
Mailing Address - Country:US
Mailing Address - Phone:614-557-3185
Mailing Address - Fax:
Practice Address - Street 1:963 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1666
Practice Address - Country:US
Practice Address - Phone:614-557-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990498-NP286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital