Provider Demographics
NPI:1902447592
Name:NICHOLS, EMMA C
Entity type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:C
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:C
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1120 TIMBERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:NE
Mailing Address - Zip Code:68621-2140
Mailing Address - Country:US
Mailing Address - Phone:402-980-1518
Mailing Address - Fax:
Practice Address - Street 1:1120 TIMBERWOOD DR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:NE
Practice Address - Zip Code:68621-2140
Practice Address - Country:US
Practice Address - Phone:402-980-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider