Individual
KEVIN NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2152 S VINEYARD STE 131, MESA, AZ 85210-6882
(855) 538-9355
(844) 538-9355
Mailing address
113 W HOOVER AVE STE 101, MESA, AZ 85210-5214
(855) 538-9355
(844) 538-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2468331
MN
Other
Enumeration date
05/16/2019
Last updated
05/16/2019
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