Individual
DR. MICHELLE NICHOLSON-WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
610 E DR MARTIN LUTHER KING JR DR, MAXTON, NC 28364-1800
(910) 844-5410
(910) 844-3290
Mailing address
60 COMMERCE DRIVE, P O BOX 1659, PEMBROKE, NC 28372-1659
(910) 521-2900
(910) 272-1654
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
94-00955
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7988330 89015A5
—
NC
Enumeration date
08/07/2006
Last updated
06/21/2010
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