Individual
NICOLE DECOUDRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
675 W NORTH AVE STE 104, MELROSE PARK, IL 60160-1622
(706) 681-7695
Mailing address
675 W NORTH AVE STE 104, MELROSE PARK, IL 60160-1622
(708) 681-7695
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004485
IL
Other
Enumeration date
10/26/2012
Last updated
07/30/2025
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