Individual
NICOLE MICHELLE THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
8221 PROVIDENT STREET, PHILADELPHIA, PA 19150
(267) 338-6382
Mailing address
8221 PROVIDENT STREET, PHILADELPHIA, PA 19150
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
RN615831
PA
Other
Enumeration date
03/21/2026
Last updated
03/21/2026
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