Individual
MELISSA ASHLEY NICKLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
808 S WOOD ST # 3E, CHICAGO, IL 60612-7300
(312) 996-8666
Mailing address
1853 W POLK ST # MC785, CHICAGO, IL 60612-4355
(847) 271-1976
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
125.079601
IL
207R00000X
Internal Medicine Physician
125.079601
IL
Other
Enumeration date
04/15/2021
Last updated
08/02/2024
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