Individual
NICOLE E AVILEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1318 KANSAS DR, PAOLA, KS 66071-2107
(913) 557-5678
(913) 557-5681
Mailing address
1318 KANSAS DR, PAOLA, KS 66071-2107
(913) 557-5678
(913) 557-5681
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02608
KS
363A00000X
Physician Assistant
2834
OK
Other
Enumeration date
01/18/2018
Last updated
12/12/2022
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