Individual
DR. GWEN LUCILLE NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
161 FORT WASHINGTON AVE, NEW YORK, NY 10032-3729
(212) 305-5705
Mailing address
630 W 168TH ST # 4, VC 12TH FLOOR, SUITE 208, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
166150
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01517528
—
NY
Enumeration date
12/05/2006
Last updated
07/08/2007
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