Individual
SAMANTHA NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9000 ROCKVILLE PIKE BLDG 10, BETHESDA, MD 20892-4009
(240) 858-3219
Mailing address
9000 ROCKVILLE PIKE BLDG 10, RM 12-C-101, BETHESDA, MD 20892-0001
(250) 858-3219
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA08988
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
338140201
—
TX
Enumeration date
04/11/2014
Last updated
08/04/2020
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