Provider Demographics
NPI:1962116210
Name:NICHOLSON, ERIN TRACI
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:TRACI
Last Name:NICHOLSON
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 1:503 HIDEAWAY DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-6743
Mailing Address - Country:US
Mailing Address - Phone:828-400-7518
Mailing Address - Fax:
Practice Address - Street 1:1998 HENDERSONVILLE RD STE 13
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2192
Practice Address - Country:US
Practice Address - Phone:828-277-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist