1306992490 NPI number — MRS. WENDY K NICHOLAS LSW

Table of content: MRS. WENDY K NICHOLAS LSW (NPI 1306992490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306992490 NPI number — MRS. WENDY K NICHOLAS LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NICHOLAS
Provider First Name:
WENDY
Provider Middle Name:
K
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISHER
Provider Other First Name:
WENDY
Provider Other Middle Name:
K
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306992490
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
534 DIETZ RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATSONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17777-7824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-524-9477
Provider Business Mailing Address Fax Number:
570-322-8029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17837-1236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-9477
Provider Business Practice Location Address Fax Number:
570-322-8029
Provider Enumeration Date:
01/25/2007

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: 104100000X , with the licence number:  SW125646 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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