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General NPI Number Information
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NPI Number | 1437469152
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Entity Type | Individual
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Provider Name | MARY NICHOLS FNP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1301 SAM PERRY BLVD
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8420
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Country | US
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Telephone | 540-741-1061
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Fax | 540-741-1096
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Provider Business Mailing Address
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Address Line | 1017 COLECHESTER ST
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City | FREDERICKSBURG
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State | VA
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Zip | 22408
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Country | US
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Telephone | 540-898-8839
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0017001572
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024105931
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License Number State | VA
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