Provider Demographics
NPI:1780650036
Name:NICHOLS, HOLLY N (NP)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:N
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 E BELL RD STE 125
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2238
Mailing Address - Country:US
Mailing Address - Phone:602-971-0268
Mailing Address - Fax:602-971-1556
Practice Address - Street 1:4045 E BELL RD STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2238
Practice Address - Country:US
Practice Address - Phone:602-971-0268
Practice Address - Fax:602-971-1556
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22657363L00000X
KS45627207N00000X, 363L00000X
AZAP7482363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266080AMedicaid
AZ011884Medicaid
KSW30734Medicare UPIN