Individual
BETH M NICKEL
Active
Individual
BETH M NICKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA055983
PA
363AS0400X
Surgical Physician Assistant
Primary
MA055983
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103230203
—
PA
01
—
12542201
CAQH
—
Enumeration date
03/19/2013
Last updated
10/12/2020
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