Provider Demographics
NPI:1447499405
Name:NICHOLSON, HEATHER ANNE (CA, MAC, DIPLAC)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:ANNE
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:CA, MAC, DIPLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 OVERLAND TRL
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7617
Mailing Address - Country:US
Mailing Address - Phone:920-410-9233
Mailing Address - Fax:
Practice Address - Street 1:155 N SAWYER ST
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902-5674
Practice Address - Country:US
Practice Address - Phone:920-410-9233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI531-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist