Individual
MS. CASSANDRA LANA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13014 E 122ND PL N, COLLINSVILLE, OK 74021-8008
(918) 406-4730
Mailing address
13014 E 122ND PL N, COLLINSVILLE, OK 74021-8008
(918) 406-4730
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
043.132882
IL
164W00000X
Licensed Practical Nurse
Primary
L0070599
OK
Other
Enumeration date
05/03/2024
Last updated
05/03/2024
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