Individual
JEFFREY GERARD NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
19035 W CAPITOL DR, SUITE 101, BROOKFIELD, WI 53045-2755
(262) 754-1421
(262) 754-3760
Mailing address
7033 WELLAUER DR, MILWAUKEE, WI 53213-3734
(414) 517-6915
(414) 877-1700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
904-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42981400
—
WI
01
—
WI1826001
MEDCARE PTAN
WI
Enumeration date
01/25/2006
Last updated
08/17/2017
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