Provider Demographics
NPI:1912153263
Name:NICHOLS, BETTY LOU (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BETTY
Middle Name:LOU
Last Name:NICHOLS
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 1:33 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1642
Mailing Address - Country:US
Mailing Address - Phone:607-324-4665
Mailing Address - Fax:
Practice Address - Street 1:33 CHURCH ST
Practice Address - Street 2:APT. 101
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1642
Practice Address - Country:US
Practice Address - Phone:607-324-4665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2009-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY08771164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse