Ieasha Nickelson, RN

Primary specialty

Occupational Health Registered NurseTaxonomy code 163WX0106X

License

041393629 Issued in IL

Practice address

1440 Clear Dr
Bolingbrook, IL 60490-5575

Phone

(708) 949-0969

NPI assigned

Jan 14, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• Evolve Nurse Consultant Services

  • Clinical Medical Laboratory
  • Bolingbrook, IL
  • NPI 1598416125
  NPD Authorized official

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

{
    "created_epoch": "1642118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642118400000",
    "number": "1447901079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 W BOUGHTON RD STE 249",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401508",
            "telephone_number": "708-949-0969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 CLEAR DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604905575",
            "telephone_number": "708-949-0969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKELSON",
        "first_name": "IEASHA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-14",
        "last_updated": "2022-01-14",
        "certification_date": "2022-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "163WX0106X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Occupational Health",
            "state": "IL",
            "license": "041393629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Laptop",
            "affiliation": "N",
            "endpointDescription": "Business laptop",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1440 Clear Dr",
            "city": "Bolingbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604905575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• New Day Place, LLC
• New Life Chiropractic, PC
• New Life Podiatry, P.C.
• New Song Health Center
• Lisa Lynn Newman, PT
• Nicole Cochrane, M.Ed.,LCPC
• Nicole Lynn Nikchevich, M.S., BCBA
• Tyler Nohren, ATC
• Stacie L Norrman, MA CCC SLP
• Amy L North

• Occupational Health Registered Nurse in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Occupational Health Registered Nurse in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.