Individual
THEODORE H NICOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
500 S CLEVELAND AVE, WESTERVILLE, OH 43081-8971
(614) 898-6659
(614) 898-8631
Mailing address
P O BOX 711052, CINCINNATI, OH 45271-0001
(614) 457-8180
(614) 583-3300
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
COA.01738-NA
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0690999
—
OH
01
—
430040270
RAILROAD MEDICARE
OH
Enumeration date
08/12/2005
Last updated
07/28/2010
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