Provider Demographics
NPI:1174776843
Name:PAULEY, NICHOLE C (CST/CSFA)
Entity type:Individual
Prefix:MS
First Name:NICHOLE
Middle Name:C
Last Name:PAULEY
Suffix:
Gender:F
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:C
Other - Last Name:LAPPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1604 VISA DR.
Mailing Address - Street 2:STE. 1
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-846-4716
Mailing Address - Fax:309-454-7348
Practice Address - Street 1:1604 VISA DR.
Practice Address - Street 2:STE. 1
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-846-4716
Practice Address - Fax:309-454-7348
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000120246ZS0410X
IL238.000.120246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist