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Individual
NICHOLE JEANETTE PRIDEMORE
Active
Individual
NICHOLE JEANETTE PRIDEMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
000000
GA
363LF0000X
Family Nurse Practitioner
303269
OH
363LF0000X
Family Nurse Practitioner
4704271769
MI
Other
Enumeration date
05/02/2007
Last updated
06/05/2023
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