Individual
LEA NICKOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1101 N CENTRAL AVE STE 200, PHOENIX, AZ 85004-1844
(602) 307-5330
Mailing address
1101 N CENTRAL AVE STE 200, PHOENIX, AZ 85004-1844
(602) 307-5330
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
183839-30
WI
363LP2300X
Primary Care Nurse Practitioner
Primary
256708
AZ
Other
Enumeration date
03/06/2020
Last updated
06/03/2021
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