Provider Demographics
NPI:1366222572
Name:NICHOLAS, ABBY DANIELLE
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:DANIELLE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10679 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-5135
Mailing Address - Country:US
Mailing Address - Phone:304-618-2326
Mailing Address - Fax:
Practice Address - Street 1:10679 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-5135
Practice Address - Country:US
Practice Address - Phone:304-618-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-04
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant