Individual
MICHAEL NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 224-1948
Mailing address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 224-1948
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840493
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010110904
—
VA
Enumeration date
01/30/2006
Last updated
05/02/2008
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