Individual
JOANNA CAMILLE NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9339 GENESEE AVE, PLAZA 39, SAN DIEGO, CA 92121-2119
(858) 455-7557
(858) 455-1287
Mailing address
PO BOX 12060, LAS VEGAS, NV 89112-0060
(702) 360-2100
(909) 557-1924
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
16008
CA
Other
Enumeration date
07/08/2009
Last updated
12/23/2011
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