| Ms Nicole Denise Nickens, MSN, A-GPNP-BC, | |
| 
					30841 Euclid Ave Ste 103, Willoughby, OH 44094-3100  | |
| (216) 441-2496 | |
| (216) 453-5966 | 
| Full Name | Ms Nicole Denise Nickens | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Practitioner | 
| Location | 30841 Euclid Ave Ste 103, Willoughby, Ohio | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1609082486 | NPI | - | NPPES | 
| 0223866 | Medicaid | OH | |
| 1609082486 | Medicaid | OH | |
| 0323866 | Medicaid | OH | |
| 2462777 | Medicaid | OH | 
| Entity Name | Rakesh Ranjan M.d. & Assoc., Inc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1033143722 PECOS PAC ID: 6507895067 Enrollment ID: O20050805000212  | 
| Entity Name | Jordan Community Residential Center | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1164068524 PECOS PAC ID: 6305210220 Enrollment ID: O20230316000356  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Ms Nicole Denise Nickens, MSN, A-GPNP-BC, 30841 Euclid Ave Ste 103, Willoughby, OH 44094-3100 Ph: (216) 441-2496  | Ms Nicole Denise Nickens, MSN, A-GPNP-BC, 30841 Euclid Ave Ste 103, Willoughby, OH 44094-3100 Ph: (216) 441-2496  | 
Samantha C Cole,  Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6005 Som Center Rd, Willoughby, OH 44094 Phone: 866-389-2727  | |
Robert William Jonath, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 36000 Euclid Avenue, Willoughby, OH 44094 Phone: 440-953-9600  | |
Kimberly Vanik, CNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 35717 Euclid Ave, Willoughby, OH 44094 Phone: 440-449-1540  | |
Ashley King, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1601 Arbor Dr, Willoughby, OH 44094 Phone: 440-339-0218  | |
Shanon Lee Mekesa Ellis, NP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 6005 Som Center Rd, Willoughby, OH 44094 Phone: 440-946-7252  | |
Alexandria Uher, FNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 35717 Euclid Ave, Willoughby, OH 44094 Phone: 440-449-1540  | |
Lisa Kuhen, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 36001 Euclid Ave, Suite C6, Willoughby, OH 44094 Phone: 440-946-0053 Fax: 440-946-1812  |