Mary E Nichols, CRNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

R071024 Issued in MD

Practice address

15005 Shady Grove Rd Ste 450
Rockville, MD 20850-6377

Phone

(301) 738-6420

Fax

(301) 738-2215

NPI assigned

Jan 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

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.

• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1407902299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15005 SHADY GROVE RD STE 450",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506377",
            "telephone_number": "301-738-6420",
            "fax_number": "301-738-2215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15005 SHADY GROVE RD STE 450",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506377",
            "telephone_number": "301-738-6420",
            "fax_number": "301-738-2215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLS",
        "first_name": "MARY",
        "middle_name": "E",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MD",
            "license": "R071024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derrick Nichols-Austin
• Dustin Nichols
• Jashira Nichols
• Keyoni Nichols
• Laith Nichols
• Wynter Nichols
• Shamiera Nicholson
• Sydney Nicholson
• Alisha Nickerson
• Sharon Nickolaus, MS, OTR/L

• Adult Health Nurse Practitioner in Rockville, MD
• Providers in Rockville, MD by specialty
• Adult Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.