Individual
JUANITA NICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2501 MCKENNA BLVD, MADISON, WI 53711-3917
(414) 704-4217
Mailing address
733 STRUCK ST UNIT 45617, MADISON, WI 53744-3660
(414) 704-4217
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
02/21/2021
Last updated
02/21/2021
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