Individual
REBECCA JANE NICELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
900 S CATON AVE, BALTIMORE, MD 21229-5201
(667) 234-2414
Mailing address
900 S CATON AVE, BALTIMORE, MD 21229-5201
(667) 234-2414
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C06056
MD
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
04/08/2016
Last updated
04/22/2016
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