Individual
KAREN RUTH NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2632 N 20TH ST, PHOENIX, AZ 85006-1339
(602) 266-2200
(602) 240-6177
Mailing address
PO BOX 61773, PHOENIX, AZ 85082-1773
(602) 682-6701
(602) 240-6177
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1009350
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
740151
—
AZ
01
—
WCSKQ
SUN HEALTH GROUP #
AZ
Enumeration date
11/16/2006
Last updated
11/01/2007
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