Individual
MRS. LILLIAN MISHELLE NICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
104 INNOVATION DR, SUITE 2000, GREENVILLE, SC 29607-5253
(864) 603-6300
(864) 603-6160
Mailing address
PO BOX 743294, ATLANTA, GA 30374-3294
(864) 603-6300
(864) 603-6160
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
17527
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2272
—
SC
Enumeration date
08/20/2011
Last updated
12/01/2016
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