Provider Demographics
NPI:1144255605
Name:NICOL, MARY E (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:NICOL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 LATHAM PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-6346
Mailing Address - Country:US
Mailing Address - Phone:319-277-2139
Mailing Address - Fax:
Practice Address - Street 1:818 LATHAM PL
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-6346
Practice Address - Country:US
Practice Address - Phone:319-277-2139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02873207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine