Provider Demographics
NPI:1114495942
Name:PRITTS, NICOLLETTE LYNN
Entity type:Individual
Prefix:MISS
First Name:NICOLLETTE
Middle Name:LYNN
Last Name:PRITTS
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 1:8264 ALLEN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-8388
Mailing Address - Country:US
Mailing Address - Phone:330-622-3487
Mailing Address - Fax:
Practice Address - Street 1:4302 ALLEN RD STE 420
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1070
Practice Address - Country:US
Practice Address - Phone:330-865-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator