Provider Demographics
NPI:1295898690
Name:NICHOLSON, ANN V (RNCS, RNPC)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:V
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:RNCS, RNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CHRISTY DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1813
Mailing Address - Country:US
Mailing Address - Phone:508-580-4611
Mailing Address - Fax:
Practice Address - Street 1:7 CHRISTY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1813
Practice Address - Country:US
Practice Address - Phone:508-580-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA90943163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0172Medicare ID - Type Unspecified