1154347631 NPI number — MRS. GINGER EILEEN HEPLER NICHOLS M.S., C.G.C, L.G.C

Table of content: MRS. GINGER EILEEN HEPLER NICHOLS M.S., C.G.C, L.G.C (NPI 1154347631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154347631 NPI number — MRS. GINGER EILEEN HEPLER NICHOLS M.S., C.G.C, L.G.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLS
Provider First Name:
GINGER
Provider Middle Name:
EILEEN HEPLER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C, L.G.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154347631
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 PILGRIM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY HOOK
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06482-1306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-426-2867
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CONNECTICUT CHILDREN'S MEDICAL CENTER
Provider Second Line Business Practice Location Address:
11 SOUTH ROAD, SUITE 120
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-837-5765
Provider Business Practice Location Address Fax Number:
860-837-5269
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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