Individual
HEIDI NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
777 KIMOLE LN, ADRIAN, MI 49221-1478
(517) 263-3393
Mailing address
4235 SECOR RD, TOLEDO, OH 43623-4231
(419) 479-5605
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704140375
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0355456
—
OH
01
—
0N11220
GROUP MEDICARE PIN
MI
01
—
P0024950
RAILROAD MEDICARE
—
Enumeration date
07/12/2005
Last updated
06/21/2011
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