Provider Demographics
NPI:1477749653
Name:NICKEL, DENISE R (ARNP CNM)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:NICKEL
Suffix:
Gender:F
Credentials:ARNP CNM
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:R
Other - Last Name:TRIBBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT CH 14389
Mailing Address - Street 2:
Mailing Address - City:PALATINE
Mailing Address - State:IL
Mailing Address - Zip Code:60055-4389
Mailing Address - Country:US
Mailing Address - Phone:785-295-8108
Mailing Address - Fax:785-231-5991
Practice Address - Street 1:634 SW MULVANE ST
Practice Address - Street 2:SUITE 209
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1678
Practice Address - Country:US
Practice Address - Phone:785-295-5330
Practice Address - Fax:785-295-5355
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS64107367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS64107OtherARNP CNM STATE LICENSE