Provider Demographics
NPI:1912712217
Name:NICHOLS, AUTUMN NICOLE
Entity type:Individual
Prefix:
First Name:AUTUMN
Middle Name:NICOLE
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 1:156 HENN HYDE RD NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1201
Mailing Address - Country:US
Mailing Address - Phone:234-600-9683
Mailing Address - Fax:
Practice Address - Street 1:156 HENN HYDE RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1201
Practice Address - Country:US
Practice Address - Phone:234-600-9683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)