Provider Demographics
NPI:1316252794
Name:NICHOLSON, EVE LAZELL (LPN)
Entity type:Individual
Prefix:
First Name:EVE
Middle Name:LAZELL
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 BRITTON DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1010
Mailing Address - Country:US
Mailing Address - Phone:623-313-6315
Mailing Address - Fax:
Practice Address - Street 1:12625 BRITTON DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1010
Practice Address - Country:US
Practice Address - Phone:623-313-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN121571164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse