Provider Demographics
NPI:1588946172
Name:NICHOLS, DEANNA (RN CCM)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:RN CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SOUTH BROADWAY
Mailing Address - Street 2:SUITE 321
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5455
Mailing Address - Country:US
Mailing Address - Phone:914-631-1611
Mailing Address - Fax:914-524-7661
Practice Address - Street 1:303 SOUTH BROADWAY
Practice Address - Street 2:SUITE 321
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-5455
Practice Address - Country:US
Practice Address - Phone:914-631-1611
Practice Address - Fax:914-524-7661
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22288762163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse