Individual
COURTNEY MARIE MCNICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-3697
Mailing address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
207Q00000X
Family Medicine Physician
Primary
0102209162
VA
208D00000X
General Practice Physician
0102209162
VA
390200000X
Student in an Organized Health Care Education/Training Program
0102209162
VA
Other
Enumeration date
12/22/2022
Last updated
05/23/2025
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