Individual
JONATHON K NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E 2ND ST STE 100, DEFIANCE, OH 43512-9905
(419) 783-3226
Mailing address
1400 E 2ND ST STE 100, DEFIANCE, OH 43512-9905
(419) 783-3226
(989) 356-8132
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
35080078
OH
208000000X
Pediatrics Physician
Primary
4301104162
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010639
—
OH
Enumeration date
07/13/2005
Last updated
02/28/2023
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