Individual
AMORET E. NICKLISCH
Active
Individual
AMORET E. NICKLISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
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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