Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 1056704A | IN |
Y | 111NI0900X | Internist | 1056704A | IN |
N | 207RA0401X | Internist - Addiction Medicine | 1056704A | IN |
NPI | 1841449774 |
---|---|
Provider Name | Patricia Nicolson |
First Address | Indianapolis, IN 46240-1865 |
Second Address | Indianapolis, IN 46240-1865 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 03/06/2014 |