Provider Demographics
NPI:1396241345
Name:HYATT, NICHOLE (MD)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:HYATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 YORK RD
Mailing Address - Street 2:
Mailing Address - City:NEW OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:17350-9553
Mailing Address - Country:US
Mailing Address - Phone:717-624-1337
Mailing Address - Fax:717-624-1795
Practice Address - Street 1:5615 YORK RD
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-9553
Practice Address - Country:US
Practice Address - Phone:717-624-1337
Practice Address - Fax:717-624-1795
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD475451207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine