Individual
JAMIE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1111 DELAFIELD ST STE 102, WAUKESHA, WI 53188-3402
(262) 683-8455
Mailing address
2500 FOX RIVER PKWY, WAUKESHA, WI 53189-7747
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7652-23
WI
Other
Enumeration date
10/02/2023
Last updated
11/18/2024
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