Individual
TERESA NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
RN103935
GA
367A00000X
Advanced Practice Midwife
Primary
RN103935
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003127951A
—
GA
05
—
003127951B
—
GA
01
—
202I422481
MEDICARE PTAN
GA
Enumeration date
08/28/2012
Last updated
12/12/2016
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