Provider Demographics
NPI:1053802231
Name:NUGENT, NICHOLE ELIZABETH
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ELIZABETH
Last Name:NUGENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 CHESTNUT PL
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9477
Mailing Address - Country:US
Mailing Address - Phone:717-798-0787
Mailing Address - Fax:
Practice Address - Street 1:207 HOUSE AVE STE 109
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2308
Practice Address - Country:US
Practice Address - Phone:717-745-6166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-23
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
PAPC013779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor