Individual
NICOLE H ILUKOWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
933 E HAVERFORD RD, BRYN MAWR, PA 19010-3819
(610) 527-3800
Mailing address
933 E HAVERFORD RD, BRYN MAWR, PA 19010-3819
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA003645L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA003645L
LICENSE
PA
Enumeration date
05/08/2007
Last updated
07/08/2007
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