Provider Demographics
NPI:1790654515
Name:NICHOLS, MARIBETH A
Entity type:Individual
Prefix:
First Name:MARIBETH
Middle Name:A
Last Name:NICHOLS
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 1:521 1ST AVE NW
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-6512
Mailing Address - Country:US
Mailing Address - Phone:253-232-9134
Mailing Address - Fax:
Practice Address - Street 1:521 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6512
Practice Address - Country:US
Practice Address - Phone:253-232-9134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-30
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide