Individual
ANDREA NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
411 E CHESTNUT ST # STREET1, LOUISVILLE, KY 40202-1713
(502) 588-3440
(502) 588-3441
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
05809
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05809
STATE LICENSE
KY
05
—
7100747700
—
KY
Enumeration date
03/27/2020
Last updated
09/06/2024
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