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Individual
NICOLE E MYERS
Active
Individual
NICOLE E MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
MA052694
PA
363AS0400X
Surgical Physician Assistant
Primary
MA052694
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103146271
—
PA
01
—
50063906
CAPITAL BC
PA
01
—
50074345
CAPITAL BLUE CROSS
PA
01
—
50111454
CAPITAL BLUE CROSS
PA
01
—
50111456
CAPITAL BLUE CROSS
PA
01
—
6622483
AETNA HMO
PA
01
—
8552892
AETNA HMO
PA
01
—
8552893
AETNA HMO
PA
01
—
867633
MEDICARE GROUP #
PA
01
—
9715533
AETNA NON HMO
PA
01
—
MA052694
LICENSE
PA
Enumeration date
09/28/2006
Last updated
03/07/2023
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