Provider Demographics
NPI:1699259069
Name:NICHOLS, DIANE MARIE (RN)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:MARIE
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 1:84-1170 FARRINGTON HWY STE A
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2060
Mailing Address - Country:US
Mailing Address - Phone:808-695-7926
Mailing Address - Fax:808-695-7928
Practice Address - Street 1:84-1170 FARRINGTON HWY STE A
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2060
Practice Address - Country:US
Practice Address - Phone:808-695-7926
Practice Address - Fax:808-695-7928
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI78335163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse