Provider Demographics
NPI:1396868394
Name:NICHOLS, WENDY S (CRNA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:S
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 MILES ST.
Mailing Address - Street 2:MILES MED. GROUP - ANESTHESIA
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543
Mailing Address - Country:US
Mailing Address - Phone:207-563-4511
Mailing Address - Fax:207-563-4103
Practice Address - Street 1:35 MILES ST.
Practice Address - Street 2:MILES MEDICAL GROUP
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543
Practice Address - Country:US
Practice Address - Phone:207-563-4511
Practice Address - Fax:207-563-4103
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME44707367500000X
MER044707367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME321630099Medicaid
MEME1871Medicare PIN