Provider Demographics
NPI:1487323218
Name:NICHOLS, MARLA
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:NICHOLS
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 1:1955 OLD CASTLE DR APT 401
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37127-3942
Mailing Address - Country:US
Mailing Address - Phone:901-270-6667
Mailing Address - Fax:
Practice Address - Street 1:1955 OLD CASTLE DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37127-3911
Practice Address - Country:US
Practice Address - Phone:901-270-6667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program