Provider Demographics
NPI:1659651842
Name:NICOL, TIMOTHY AARON (LPN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:AARON
Last Name:NICOL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15540 PINKLEY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43019-8006
Mailing Address - Country:US
Mailing Address - Phone:740-507-2575
Mailing Address - Fax:
Practice Address - Street 1:15540 PINKLEY RD
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:OH
Practice Address - Zip Code:43019-8006
Practice Address - Country:US
Practice Address - Phone:740-507-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.144455-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse