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Individual

WESLEY NICHOLLS JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPN

Contact information

Practice address
1201 NW 16TH ST, MIAMI, FL 33125-1624
(305) 575-7000
Mailing address
1456 NW 81ST TER, PLANTATION, FL 33322-4663
(321) 223-2508

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5177610
FL

Other

Enumeration date
01/28/2014
Last updated
01/28/2014
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