Provider Demographics
NPI:1912775024
Name:NICHOLS, NICOLE ANNE (APN-CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 W CENTRAL RD STE 4400
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2386
Mailing Address - Country:US
Mailing Address - Phone:847-483-9400
Mailing Address - Fax:847-483-9426
Practice Address - Street 1:880 W CENTRAL RD STE 4400
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2386
Practice Address - Country:US
Practice Address - Phone:847-493-9400
Practice Address - Fax:847-483-9426
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner