Provider Demographics
NPI:1801290432
Name:BENDER, NICOLE (EDS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BENDER
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6763 ED LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8210
Mailing Address - Country:US
Mailing Address - Phone:330-473-0094
Mailing Address - Fax:
Practice Address - Street 1:955 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8045
Practice Address - Country:US
Practice Address - Phone:740-653-3193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3149295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOH3149295OtherEDUCATOR STATE ID