Provider Demographics
NPI:1487114542
Name:NICHOLS, SANDY LYNN (RN)
Entity type:Individual
Prefix:
First Name:SANDY
Middle Name:LYNN
Last Name:NICHOLS
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 1:891 RUSHMORE ST
Mailing Address - Street 2:
Mailing Address - City:JENISON
Mailing Address - State:MI
Mailing Address - Zip Code:49428-9368
Mailing Address - Country:US
Mailing Address - Phone:616-485-1999
Mailing Address - Fax:
Practice Address - Street 1:891 RUSHMORE ST
Practice Address - Street 2:
Practice Address - City:JENISON
Practice Address - State:MI
Practice Address - Zip Code:49428-9368
Practice Address - Country:US
Practice Address - Phone:616-485-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2019-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704202137163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse