Provider Demographics
NPI:1386094597
Name:NICHOLS ROSS, EVELYN LOUISE (RN)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LOUISE
Last Name:NICHOLS ROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23305 CHAGRIN BLVD APT 304
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5518
Mailing Address - Country:US
Mailing Address - Phone:216-640-4706
Mailing Address - Fax:
Practice Address - Street 1:23305 CHAGRIN BLVD APT 304
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5518
Practice Address - Country:US
Practice Address - Phone:216-640-4706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-18
Last Update Date:2016-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHR.N 234492163W00000X, 163WC1500X, 163WC3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC3500XNursing Service ProvidersRegistered NurseCardiac Rehabilitation