Individual
DR. SUSANNAH E. NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4502 MEDICAL DR, SAN ANTONIO, TX 78229-4402
(210) 358-2015
Mailing address
7703 FLOYD CURL DR, SAN ANTONIO, TX 78229-3901
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
P6688
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
322089901
—
TX
01
—
322089902
MEDICAID CSHCN
TX
Enumeration date
01/08/2008
Last updated
11/26/2013
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