Individual
JANE ELIZABETH NICHOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 PENNSYLVANIA AVE, CHARLESTON, WV 25302-3351
(304) 414-1880
(304) 414-1886
Mailing address
97 GREAT TEAYS BLVD, STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 201-5019
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
20979
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3003934000
—
WV
Enumeration date
07/16/2009
Last updated
08/12/2020
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