Provider Demographics
NPI:1427892041
Name:NICOLAS, LOURICHA LOUSUCA
Entity type:Individual
Prefix:
First Name:LOURICHA
Middle Name:LOUSUCA
Last Name:NICOLAS
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 1:5440 RIVER GLEN DR UNIT 382
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-7418
Mailing Address - Country:US
Mailing Address - Phone:702-542-5606
Mailing Address - Fax:
Practice Address - Street 1:5440 RIVER GLEN DR UNIT 382
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-7418
Practice Address - Country:US
Practice Address - Phone:702-542-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747A0650X, 374U00000X, 343900000X
NVCNA036054376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide