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Organization

KIMBERLY NICHELSON DPM

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KIMBERLY M NICHELSON DPM (CEO)
(419) 750-0041
Entity
Organization

Contact information

Practice address
630 E RIVER ST, ELYRIA, OH 44035-5902
(419) 750-0041
Mailing address
108 TRAILHEAD LN, BEREA, OH 44017-1099
(419) 750-0041

Taxonomy

Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
36.003767
STATE LICENSE
OH
Enumeration date
09/06/2022
Last updated
09/06/2022
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