Provider Demographics
NPI:1285617522
Name:POURIER, NICHOLE L (APRN)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:L
Last Name:POURIER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:L
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:825 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-9400
Mailing Address - Country:US
Mailing Address - Phone:308-432-0264
Mailing Address - Fax:
Practice Address - Street 1:300 SHELTON ST
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-2312
Practice Address - Country:US
Practice Address - Phone:308-432-4441
Practice Address - Fax:308-432-4446
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110663363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE278525Medicare ID - Type UnspecifiedPERFORMING PROVIDER #
NEQ33542Medicare UPIN