Provider Demographics
NPI:1114357993
Name:BACHMANN, NICOLE
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BACHMANN
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 1:760 CHESSIE CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-8768
Mailing Address - Country:US
Mailing Address - Phone:410-255-0102
Mailing Address - Fax:410-255-0103
Practice Address - Street 1:760 CHESSIE CROSSING WAY
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8768
Practice Address - Country:US
Practice Address - Phone:410-255-0102
Practice Address - Fax:410-255-0103
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR177026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily