Individual
MARISA LEIGH NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
23077 GREENFIELD RD STE 253, SOUTHFIELD, MI 48075-3750
(248) 559-5950
(248) 559-2103
Mailing address
9919 BERWYN, REDFORD, MI 48239-2120
(734) 386-9425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012050
MI
Other
Enumeration date
09/13/2023
Last updated
05/12/2025
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