Individual
LESLIE A NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
21401 ALLEN RD, WOODHAVEN, MI 48183-1665
(734) 675-0835
(734) 675-0873
Mailing address
336 29TH ST, ASHLAND, KY 41101-1900
(606) 324-4404
(606) 325-6822
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
5601006720
MI
363AS0400X
Surgical Physician Assistant
PA653
KY
Other
Enumeration date
05/06/2006
Last updated
01/14/2025
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