Individual
MRS. LEJOY SHAWNETTE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPRS
Contact information
Practice address
1380 ENERGY LN STE 201, SAINT PAUL, MN 55108-5253
(651) 983-7892
Mailing address
1380 ENERGY LN STE 201, SAINT PAUL, MN 55108-5253
(651) 983-7892
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
8241
MN
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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