Individual
AMANDA DIANE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3 E BENJAMIN DR, NEW MARTINSVILLE, WV 26155-2705
(304) 455-8080
(304) 455-8141
Mailing address
3 E BENJAMIN DR, NEW MARTINSVILLE, WV 26155-2705
(304) 455-8080
(304) 455-8141
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21641
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810000901
—
WV
Enumeration date
09/22/2005
Last updated
04/18/2022
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