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Individual

NICOLE LYNN MCQUILLAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
111 S FRONT ST, HARRISBURG, PA 17101-2010
(717) 988-0000
(717) 782-5716
Mailing address
604 STONEY RUN RD, POTTSVILLE, PA 17901-8729
(570) 933-0890

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
005930
PA
363AM0700X
Medical Physician Assistant
Primary
063183
PA

Other

Enumeration date
11/22/2021
Last updated
11/26/2021
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