Individual
MS. BRENDA J NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 464-6170
Mailing address
1111 LEFFINGWELL AVE NE, GRAND RAPIDS, MI 49525-6406
(616) 459-7101
(616) 464-6170
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085-002520
IL
363A00000X
Physician Assistant
2100
WI
363A00000X
Physician Assistant
Primary
5601006279
MI
Other
Enumeration date
12/27/2006
Last updated
05/13/2022
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