Provider Demographics
NPI:1114742095
Name:SHRIVER, NICHOLE PAIGE (APRN, CNP)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:PAIGE
Last Name:SHRIVER
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12952 STATE ROUTE 39
Mailing Address - Street 2:
Mailing Address - City:BIG PRAIRIE
Mailing Address - State:OH
Mailing Address - Zip Code:44611-9682
Mailing Address - Country:US
Mailing Address - Phone:330-473-9619
Mailing Address - Fax:
Practice Address - Street 1:1330 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1495
Practice Address - Country:US
Practice Address - Phone:740-393-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0038120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily