Provider Demographics
NPI:1396322475
Name:NICHOLSON, MARGARET M (RN)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:NICHOLSON
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 1:4052 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1135
Mailing Address - Country:US
Mailing Address - Phone:708-670-0797
Mailing Address - Fax:
Practice Address - Street 1:1017 W WASHINGTON BLVD UNIT 6D
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2112
Practice Address - Country:US
Practice Address - Phone:708-670-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL495610163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support