Individual
DR. SANDRA BRUCE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12018 SUNRISE VALLEY DR, SUITE 400, RESTON, VA 20191-3432
(301) 448-6550
Mailing address
12706 YOUNG LN, NORTH POTOMAC, MD 20878-6112
(301) 947-6774
(131) 094-7677
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
D60180
MD
302R00000X
Health Maintenance Organization
Primary
D60180
MD
Other
Enumeration date
09/21/2011
Last updated
09/21/2011
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