Individual
PHEDELINE NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1746 PLEASANT HILL TRL, LITHONIA, GA 30058-5819
(718) 519-7672
Mailing address
1746 PLEASANT HILL TRL, LITHONIA, GA 30058-5819
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
216596-1
NY
Other
Enumeration date
05/06/2008
Last updated
05/06/2008
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