Provider Demographics
NPI:1144985557
Name:BAIN, NIA-NICOLE
Entity type:Individual
Prefix:
First Name:NIA-NICOLE
Middle Name:
Last Name:BAIN
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 1:3656 RIPLEY TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7510
Mailing Address - Country:US
Mailing Address - Phone:845-445-5450
Mailing Address - Fax:
Practice Address - Street 1:3656 RIPLEY TRAIL DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7510
Practice Address - Country:US
Practice Address - Phone:845-445-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide