Individual
MRS. JULIE ANNE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED, CALT/LDT
Contact information
Practice address
15107 COG HL, SELMA, TX 78154-1327
(210) 459-0641
Mailing address
16765 LOOKOUT RD, SELMA, TX 78154-3809
(210) 656-2999
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2050
TX
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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