Provider Demographics
NPI:1982811329
Name:MCNICHOLS, LUCILLE MARIE
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:MARIE
Last Name:MCNICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 119A
Mailing Address - Street 2:
Mailing Address - City:GORIN
Mailing Address - State:MO
Mailing Address - Zip Code:63543-9761
Mailing Address - Country:US
Mailing Address - Phone:660-282-3335
Mailing Address - Fax:660-282-3335
Practice Address - Street 1:RR 1 BOX 119A
Practice Address - Street 2:
Practice Address - City:GORIN
Practice Address - State:MO
Practice Address - Zip Code:63543-9761
Practice Address - Country:US
Practice Address - Phone:660-282-3335
Practice Address - Fax:660-282-3335
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography