Individual
JACQUELINE WYNNE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 CENTRAL ST STE 700, EVANSTON, IL 60201-1769
(847) 869-3300
(847) 869-1303
Mailing address
2801 LAKESIDE DR STE 209, BANNOCKBURN, IL 60015-1200
(847) 562-1410
(847) 929-4605
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
036166140
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2019
Last updated
10/05/2023
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