Provider Demographics
NPI:1649071259
Name:NICHOLS, MACKINZIE C
Entity type:Individual
Prefix:
First Name:MACKINZIE
Middle Name:C
Last Name:NICHOLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13688 GARGONIA RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8233
Mailing Address - Country:US
Mailing Address - Phone:513-767-8913
Mailing Address - Fax:
Practice Address - Street 1:13688 GARGONIA RD
Practice Address - Street 2:
Practice Address - City:MOUNT ORAB
Practice Address - State:OH
Practice Address - Zip Code:45154-8233
Practice Address - Country:US
Practice Address - Phone:513-767-8913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health