Provider Demographics
NPI:1386427854
Name:NICHOLS, HEAVENLY A
Entity type:Individual
Prefix:MRS
First Name:HEAVENLY
Middle Name:A
Last Name:NICHOLS
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 1:6396 BUSCH BLVD APT 404
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1849
Mailing Address - Country:US
Mailing Address - Phone:740-603-1404
Mailing Address - Fax:
Practice Address - Street 1:6396 BUSCH BLVD APT 404
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1849
Practice Address - Country:US
Practice Address - Phone:740-603-1404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide