Provider Demographics
NPI:1154341741
Name:NICHOLS, AMANDA E (CNP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:E
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:E
Other - Last Name:WEATHERBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:30575 BAINBRIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2275
Mailing Address - Country:US
Mailing Address - Phone:440-368-6868
Mailing Address - Fax:440-368-6866
Practice Address - Street 1:30575 BAINBRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2275
Practice Address - Country:US
Practice Address - Phone:440-368-6868
Practice Address - Fax:440-368-6866
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08915363LF0000X
OHRN293365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200831990Medicaid
KY78017902Medicaid
OH2679463Medicaid
OHNP21171Medicare PIN
IN200831990Medicaid
KY78017902Medicaid