Provider Demographics
NPI:1760296495
Name:NICHOLS, THERESA
Entity type:Individual
Prefix:
First Name:THERESA
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 1:2836 MCCUTCHEON RUN
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:WV
Mailing Address - Zip Code:26160-8483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2836 MCCUTCHEON RUN
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:WV
Practice Address - Zip Code:26160-8483
Practice Address - Country:US
Practice Address - Phone:304-377-9453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant