Provider Demographics
NPI:1285260166
Name:NICHOLSON, HAROLD THOMAS (RN)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:THOMAS
Last Name:NICHOLSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4212 NE KENNESAW RDG
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1379
Mailing Address - Country:US
Mailing Address - Phone:816-616-6376
Mailing Address - Fax:
Practice Address - Street 1:4212 NE KENNESAW RDG
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1379
Practice Address - Country:US
Practice Address - Phone:816-616-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108988163WI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001673730OtherSTATE OF MISSOURI