Individual
STEPHANIE RENEE NICKELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 SANGO DR, CLARKSVILLE, TN 37043-6822
(931) 368-9622
Mailing address
71 ELLINGTON TER, CLARKSVILLE, TN 37040-5147
(931) 220-3116
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
0000000134
TN
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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