Provider Demographics
NPI:1841437530
Name:NICHOLS, COURTNEY DAWN (SCM)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DAWN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:SCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 N BROADWAY
Mailing Address - Street 2:RM 543
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1832
Mailing Address - Country:US
Mailing Address - Phone:816-550-9804
Mailing Address - Fax:
Practice Address - Street 1:733 N BROADWAY
Practice Address - Street 2:RM 543
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1832
Practice Address - Country:US
Practice Address - Phone:410-502-7541
Practice Address - Fax:410-502-7544
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS