Individual provider Active NPI

Laurie A Nichols, RN, APN-C

  • General Practice Registered Nurse
  • Vineland, NJ
National Provider Identifier
1003041427
Registry record updated Feb 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
License
26NJ00189000 Issued in NJ
Practice address
2848 S Delsea Dr Ste 2C
Vineland, NJ 08360-7042
Phone
(856) 794-9090
NPI assigned
May 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 26NJ00189000 NJ Primary

Addresses

Primary practice location

2848 S Delsea Dr Ste 2C
Vineland, NJ 08360-7042

Mailing address

2848 S Delsea Dr Ste 2C
Vineland, NJ 08360-7042
Phone (856) 794-9090

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100430000016 NJ Practitioner - Nurse Practitioner 6103953765 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner, Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Care, Inc. CurrentSince Mar 30, 2010 Accepting new patients
Nurse Practitioner Professional Resources CurrentSince Feb 1, 2021 Accepting new patients
Community Health Care, Inc. CurrentSince Mar 30, 2010 Accepting new patients
Arthritis & Rheumatology Associates of South Jersey PC PastSince Feb 23, 2020 Accepting new patients

Locations

30 N Pearl St
Bridgeton, NJ 08302

53 S Laurel St
#2
Bridgeton, NJ 08302

335 Delsea Dr N
Glassboro, NJ 08028
Phone (856) 863-5720

319 W Landis Ave
Vineland, NJ 08360
Phone (856) 690-5701

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/26288/brand/1/csg/1/fhir/r4

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1243555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581897600000",
    "number": "1003041427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2848 S DELSEA DR STE 2C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607042",
            "telephone_number": "856-794-9090",
            "fax_number": "856-794-3058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2848 S DELSEA DR STE 2C",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083607042",
            "telephone_number": "856-794-9090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "LAURIE",
        "middle_name": "A",
        "credential": "RN, APN-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-29",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "NJ",
            "license": "26NJ00189000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.