Provider Demographics
NPI:1457196255
Name:NICHOLS, ANGELIA BROOKE
Entity type:Individual
Prefix:
First Name:ANGELIA
Middle Name:BROOKE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W NORTH ST
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45801-4217
Mailing Address - Country:US
Mailing Address - Phone:419-496-8700
Mailing Address - Fax:
Practice Address - Street 1:630 W NORTH ST
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-4217
Practice Address - Country:US
Practice Address - Phone:419-496-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care