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Jean L Nicholas

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

9900 Bren Rd E, Minnetonka, MN 55343-9664

PECOS Enrollment

This provider is enrolled in PECOS as JEAN NICHOLAS.

Based on the most recent information from CMS, provider Jean L Nicholas is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1770551608
Provider Type
Individual
Full Name
Nicholas, Jean L
Title
Mrs.
Credential
CRNP

Gender
Female
Sole Proprietor
Yes
Enumeration Date
3/8/2006
Last Updated
6/28/2020

Contact Information

Practice Location

9900 Bren Rd E, Minnetonka, MN 55343-9664

(000) 000-0000

Unlisted Fax

Mailing Location

9900 Bren Road East, Mail Route Mn 008-B213, Minnetonka, MN 55343

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License NP03003 Ohio

Jean L Nicholas

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Sullivan, Elizabeth Mary

Scalone, Ginger D.

Thayer, Lisa

York, Dara Newsome

Withers, Scott Edward

United Healthcare Services, Inc

Huber, Theresa

Graf, Angelita L

Tedford, Abby Gail

Shirley, Grace A