| Doctor Name: | TRINA NICHOLS |
| NPI Number: | 1073980306 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 634115 |
| Business Practice Address: | 2155 State Route 22b Morrisonville, NY - 129623417 |
| Business Phone Number: | 5185638000 |
| Business Fax Number: | 5185613490 |
| Mailing Address: | 610 State Route 22b, PERU |
| State: | NY |
| Postal Code: | 129725416 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 08/21/2015 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0809X |
| License Number: | 634115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health, Adult |
| Taxonomy Definition: | |