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Individual

MICHELLE D NICHOLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
100 MEMORIAL HOSPITAL DR, SUITE 3A, MOBILE, AL 36608-1183
(251) 342-2641
(251) 343-9507
Mailing address
100 MEMORIAL HOSPITAL DR, SUITE 3A, MOBILE, AL 36608-1183
(251) 342-2641
(251) 343-9507

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA550
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009914168
AL
01
051545351
BLUE CROSS BLUE SHIELD
AL
Enumeration date
09/24/2007
Last updated
07/27/2010
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