Provider Demographics
NPI:1366642365
Name:NICHOLS, HEATHER RUTHANN (MD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:RUTHANN
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2709
Mailing Address - Country:US
Mailing Address - Phone:812-882-8510
Mailing Address - Fax:812-885-8511
Practice Address - Street 1:514 S 9TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2709
Practice Address - Country:US
Practice Address - Phone:812-882-8510
Practice Address - Fax:812-885-8511
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068320A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000681708OtherANTHEM
IN201003480Medicaid
IN262813100OtherTAX ID
IN26-3086555OtherTAX I.D.
IN262813100OtherTAX ID
IN26-3086555OtherTAX I.D.