Provider Demographics
NPI:1932878980
Name:NORMAN, NICOLE L (INDEPENDENT PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:NORMAN
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 STATE ROUTE 314 S
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44903-7733
Mailing Address - Country:US
Mailing Address - Phone:567-241-8764
Mailing Address - Fax:
Practice Address - Street 1:1010 STATE ROUTE 314 S
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-7733
Practice Address - Country:US
Practice Address - Phone:567-241-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-12
Last Update Date:2021-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7003414OtherCONTRACT NUMBER FOR DODD