Provider Demographics
NPI:1316812969
Name:NICHOLAS, CAROLYN JEAN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JEAN
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 WOLF RUN RD
Mailing Address - Street 2:
Mailing Address - City:ORMA
Mailing Address - State:WV
Mailing Address - Zip Code:25268-8736
Mailing Address - Country:US
Mailing Address - Phone:304-701-0467
Mailing Address - Fax:
Practice Address - Street 1:1102 WOLF RUN RD
Practice Address - Street 2:
Practice Address - City:ORMA
Practice Address - State:WV
Practice Address - Zip Code:25268-8736
Practice Address - Country:US
Practice Address - Phone:304-701-0467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant