Individual
DR. KIM MYRUTH NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
469 W PUTNAM AVE, SUITE 201, GREENWICH, CT 06830-6895
(203) 862-4000
(203) 862-4008
Mailing address
469 W PUTNAM AVE, SUITE 201, GREENWICH, CT 06830-6895
(203) 862-4000
(203) 862-4008
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
051631
CT
207N00000X
Dermatology Physician
239556
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051631
STATE LICENSE
CT
Enumeration date
06/08/2006
Last updated
01/06/2014
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