Provider Demographics
NPI:1215517685
Name:WARE, NIKIA L (RN MSN ED MBA)
Entity type:Individual
Prefix:
First Name:NIKIA
Middle Name:L
Last Name:WARE
Suffix:
Gender:F
Credentials:RN MSN ED MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3075 SPRING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5530
Mailing Address - Country:US
Mailing Address - Phone:815-979-7303
Mailing Address - Fax:
Practice Address - Street 1:3075 SPRING LAKE DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5530
Practice Address - Country:US
Practice Address - Phone:815-979-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-10
Last Update Date:2021-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041321546163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty