Provider Demographics
NPI:1841482924
Name:HIATT, NICOLE RACHEL (LPN)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RACHEL
Last Name:HIATT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 WINDHAVEN CIR APT H
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-8093
Mailing Address - Country:US
Mailing Address - Phone:765-277-2804
Mailing Address - Fax:
Practice Address - Street 1:1117 WINDHAVEN CIR APT H
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8093
Practice Address - Country:US
Practice Address - Phone:765-277-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL43086794164W00000X
MDLP43059164W00000X
IN27055341A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse