Individual
LISA M NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
407 W INDIANA AVE, CHESTERTON, IN 46304-2350
(219) 763-8112
(219) 764-5380
Mailing address
PO BOX 1430, PORTAGE, IN 46368-9230
(219) 763-8112
(219) 764-5384
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71006113A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201348700
—
IN
Enumeration date
03/02/2016
Last updated
11/25/2020
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