Provider Demographics
NPI:1871884262
Name:HARRISON, NIKOLE BERNADETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:BERNADETTE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6174 SEMINOLE TRL
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-2953
Mailing Address - Country:US
Mailing Address - Phone:440-231-6298
Mailing Address - Fax:
Practice Address - Street 1:6174 SEMINOLE TRL
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-2953
Practice Address - Country:US
Practice Address - Phone:440-231-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.342347163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse