Individual
MS. JOHNNETTA MATRICE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
102737
TX
310400000X
Assisted Living Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861636896
—
TX
05
—
205828380
—
TX
05
—
F500193420
—
TX
Enumeration date
04/21/2009
Last updated
04/26/2024
Update your record
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