Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 098597 | MO |
N | 363LN0000X | Nurse Practitioner - Neonatal | 44413 | KS |
NPI | 1073758322 |
---|---|
Provider Name | Beth D. Nichols |
First Address | Sunrise, FL 33323-2826 |
Second Address | Kansas City, MO 64111-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2008 |
Last Update Date | 15/12/2008 |