Provider Demographics
NPI:1427280411
Name:NICHOLAS, IRISH R (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:IRISH
Middle Name:R
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3922
Mailing Address - Country:US
Mailing Address - Phone:760-693-4617
Mailing Address - Fax:
Practice Address - Street 1:1109 S 7TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3922
Practice Address - Country:US
Practice Address - Phone:760-693-4617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634404163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse