Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 5947 | NC |
NPI | 1053820019 |
---|---|
Provider Name | Mrs. Patricia Renee Nichols |
First Address | Clayton, NC 27527-4218 |
Second Address | Smithfield, NC 27577-6970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 21/09/2017 |