Provider Demographics
NPI:1871745745
Name:NICHOLSON, CAROL M (CAROL NICHOLSON,EDM)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:CAROL NICHOLSON,EDM
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:M
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CAROL MALYSZKA
Mailing Address - Street 1:156 FRONTENAC AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1929
Mailing Address - Country:US
Mailing Address - Phone:716-833-6710
Mailing Address - Fax:
Practice Address - Street 1:156 FRONTENAC AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1929
Practice Address - Country:US
Practice Address - Phone:716-833-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor