Individual
DR. TIFFANI MARIA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
716 SPRING ST, SUITE 204, WISE, VA 24293
(276) 328-8910
(276) 328-4318
Mailing address
716 SPRING ST, SUITE 204, WISE, VA 24293
(276) 328-8910
(276) 328-4318
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0102202126
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760678106
—
VA
05
—
7100077080
—
KY
01
—
P00739464
RR MEDICARE
—
Enumeration date
09/19/2007
Last updated
02/22/2017
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