Individual
JACQUELYN MARIE NICKELE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1815 BARDSTOWN RD, LOUISVILLE, KY 40205-1433
(502) 459-4120
Mailing address
PO BOX 860036, MINNEAPOLIS, MN 55486-0036
(502) 459-4120
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9476
KY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
12012676A
IN
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
9476
KY
Other
Enumeration date
04/28/2014
Last updated
05/31/2017
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