Individual
AMORET E. NICKLISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2020 SUTTER PL STE 101, DAVIS, CA 95616
(530) 750-5900
(530) 750-5891
Mailing address
10470 OLD PLACERVILLE RD STE 100, SACRAMENTO, CA 95827-2539
(800) 470-0071
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
19105
CA
363AM0700X
Medical Physician Assistant
Primary
PA19105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
19105
MEDICAL BOARD OF PA
CA
Enumeration date
06/28/2007
Last updated
02/27/2019
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