Jolleen Mary Nichols, DNP is a medicare enrolled "Nurse Practitioner - Adult Health" in Clear Lake, Wisconsin. Her current practice location is
357 Third Ave, Clear Lake, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(715) 268-8000.
Jolleen Mary Nichols is licensed to practice in Wisconsin (license number 9572) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1770134892.
Provider's Profile
Full Name | Jolleen Mary Nichols |
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Gender | Female |
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Speciality | Nurse Practitioner - Adult Health |
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Location | 357 Third Ave, Clear Lake, Wisconsin |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1770134892
- Provider Enumeration Date: 09/20/2019
- Last Update Date: 10/03/2019
Medicare PECOS Information:
- PECOS PAC ID: 4082046271
- Enrollment ID: I20191108000520
Medical Identifiers
Medical identifiers for Jolleen Mary Nichols such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1770134892 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363LA2200X | Nurse Practitioner - Adult Health | 9572 (Wisconsin) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jolleen Mary Nichols allows following entities to bill medicare on her behalf.
Entity Name | Amery Regional Medical Center Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1093763518 PECOS PAC ID: 2769391960 Enrollment ID: O20040131000207 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jolleen Mary Nichols is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Jolleen Mary Nichols, DNP 633 210th Ave, Somerset, WI 54025-6940 Ph: (651) 226-3906 | Jolleen Mary Nichols, DNP 357 Third Ave, Clear Lake, WI 54005 Ph: (715) 268-8000 |
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