Individual
MS. JANIS M NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA,APRN,CS
Contact information
Practice address
278 GOODALE DRIVE, NEWINGTON, CT 06111-3131
(860) 667-0665
(860) 667-0665
Mailing address
278 GOODALE DRIVE, NEWINGTON, CT 06111-3131
(860) 667-0665
(860) 667-0665
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
APRN 000804
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
400000804CT02
ANTHEM BCBS
CT
Enumeration date
11/27/2006
Last updated
06/17/2008
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