Individual
MR. ANDRA L NICHOLSON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1724 W CLARKE ST, MILWAUKEE, WI 53206-2030
(414) 763-9892
(414) 763-0531
Mailing address
1724 W CLARKE ST, MILWAUKEE, WI 53206-2030
(414) 763-9892
(414) 763-0531
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
N242-0126-3466-07
WI
Other
Enumeration date
10/28/2021
Last updated
12/05/2023
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