Healthcare Provider Details

I. General information

NPI: 1366273203
Provider Name (Legal Business Name): ZOEY NICHOLS GC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 OGLETOWN RD SUITE 220
NEWARK DE
19713
US

IV. Provider business mailing address

107 COTTON ST APT 5
PHILADELPHIA PA
19127-1561
US

V. Phone/Fax

Practice location:
  • Phone: 302-623-0106
  • Fax: 302-623-4845
Mailing address:
  • Phone: 301-643-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: