MARY SUE NICHOLSON (NPI# 1063662849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063662849 |
| Entity Type | Individual |
| Full Name | MARY SUE NICHOLSON |
| Credential | CRNP |
| Practice Address |
4098 Edgmont Ave Brookhaven PA 19015-2211 |
| Mailing Address |
161 Washington St Eight Tower Bridge Ste 1400 Conshohocken PA 19428-2083 |
| Practice Telephone | 8668253227 |
| Practice Fax Number | 4844502617 |
| Mailing Telephone | 8668253227 |
| Mailing Fax Number | 4844502617 |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2008-09-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
SP007470 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396235032 | Mary Nicholson | Social Worker | 2404 Blue Haven Dr, New Iberia, LA 70563-2133 | 2018-05-17 |
| 1063817971 | Mary Jane Nicholson | Counselor | 1800 Edinburgh Street, Rawlins, WYOMING 82301 | 2014-11-04 |
| 1215090261 | Mary Alice Nicholson | Psychologist | 400 E Red Bridge Rd, 304, Kansas City, MO 64131-4035 | 2006-12-19 |
| 1306839667 | Mary H Nicholson | Radiology | 901 Macarthur Blvd, Munster Radiology Group, Munster, IN 46321-2901 | 2005-08-23 |
| Street Address |
4098 EDGMONT AVE |
| City | BROOKHAVEN |
| State | PA |
| Zip Code | 19015-2211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215942206 | Walgreen Eastern Co Inc | Durable Medical Equipment & Medical Supplies | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2006-07-29 |
| 1194326884 | Maksim Daku | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2020-11-08 |
| 1407468895 | Richard Dong | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2020-08-18 |
| 1265080378 | Kenny Khoi Ao | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2019-09-02 |
| 1780119933 | Sean Mcdade | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2017-04-25 |
| 1366710873 | Brian J Graci | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2011-12-12 |
| 1205118122 | John C Cavallaro | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2011-09-16 |
| 1174804330 | Kimberly Nicole Kleeman | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2011-09-01 |
| 1083995245 | Xiem Nguyen-yip | Pharmacist | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2011-09-01 |
| 1265634042 | Sieda Barrow | Nurse Practitioner | 4098 Edgmont Ave, Brookhaven, PA 19015-2211 | 2007-06-04 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487262614 | Hometown Rx Services | Pharmacy | 3406 Edgmont Avenue, Suite B, Brookhaven, PA 19015 | 2020-07-14 |
| 1932650926 | Giant Food Stores LLC | Durable Medical Equipment & Medical Supplies | 4930 Edgemont Ave, Brookhaven, PA 19015 | 2016-10-14 |
| 1982009254 | Communities of Don Guanella and Divine Providence | Intermediate Care Facility, Mentally Retarded | 225 Upland Road, Brookhaven, PA 19015 | 2014-10-29 |
| 1790959633 | Darlene M Longstreth | Massage Therapist | 3766 Susan Lane, Kinderssage, Brookhaven, PA 19015 | 2008-04-22 |
| 1538205463 | Scott Thomas Steltz | Pharmacist | 601 Upland Ave Suite 112, Steltec Pharmacy - Crozier Mills Enterprise Center, Upland, PA 19015 | 2007-01-29 |
| 1083769327 | Parkside Fire Company | Ambulance | 107 West Roland, Parkside, PA 19015 | 2007-01-25 |
| 1295894699 | Elizabeth Katherine Deegan | Counselor | 4928 Shepard St., Brookhaven, PA 19015 | 2006-12-08 |
| 1013093244 | Jeffrey Keith Rosen | Family Medicine | 100 East Brookhaven Rd, Brookhaven, PA 19015 | 2006-10-31 |
| 1013015726 | Pennsylvania Cvs Pharmacy, L.L.C. | Durable Medical Equipment & Medical Supplies | 3298 Edgemont Ave, Brookhaven, PA 19015 | 2006-09-20 |
| 1285743187 | Micheal A Erbicella | Dentist | 3213 Edgmont Ave, Brookhaven, PA 19015 | 2006-08-30 |
| Find all providers in zip 19015 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255946018 | Jacob Warren Spring | Nurse Practitioner | 414 Hardy Ln, Brookhaven, MS 39601-4046 | 2020-09-09 |
| 1306464425 | Mollie Maria Bowman | Nurse Practitioner | 2165 Prestwick Ct Ne, Brookhaven, GA 30319-4083 | 2020-07-07 |
| 1013534478 | Candace Laird Duckworth | Nurse Practitioner | 1578 Shanna Ln Nw, Brookhaven, MS 39601-4420 | 2020-07-01 |
| 1750748729 | Babatunde Adenusi | Nurse Practitioner | 435 W Brookhaven Rd, Brookhaven, PA 19015-1801 | 2016-01-21 |
| 1265825962 | Leah Smith Mcgehee | Nurse Practitioner | 201 Highway 51 N Ste A, Brookhaven, MS 39601-2653 | 2015-03-05 |
| 1598011090 | Carolyn Sandra Hayes-dozier | Nurse Practitioner | 1616 Powell Rd, Brookhaven, PA 19015-1934 | 2012-08-02 |
| 1215297239 | Lorraine Claudia Blagman | Nurse Practitioner | 4021 Woodworth Rd, Brookhaven, PA 19015-1913 | 2012-05-23 |
| 1386658763 | Catherine W. Knott | Nurse Practitioner | 950 Brookman Blvd, Brookhaven, MS 39601 | 2006-07-28 |
| 1689659864 | Brookhaven Anesthesia & Pain Management | Nurse Practitioner | 1024 D A Biglane Dr, Brookhaven, MS 39601-2331 | 2005-12-12 |
| 1679107692 | Tucker Lee Brady | Nurse Practitioner | 940 Brookway Blvd, Brookhaven, MS 39601-2644 | 2020-02-28 |
| Find all providers in BROOKHAVEN | ||||
| City | BROOKHAVEN |
| Zip Code | 19015 |
Please comment or provide details below to improve the information on MARY SUE NICHOLSON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.