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General NPI Number Information
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NPI Number | 1518227594
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Entity Type | Individual
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Provider Name | ANNA JEANNINE NICHOLS M.D., PH.D.
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Gender | Female
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Dates
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Enumeration Date | 05/23/2012
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 2 HEALEY AVE
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2413
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Country | US
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Telephone | 802-864-0192
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Fax | 802-860-4919
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Provider Business Mailing Address
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Address Line | 354 MOUNTAIN VIEW DR STE 300
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City | COLCHESTER
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State | VT
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Zip | 05446-5988
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Country | US
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Telephone | 802-864-0192
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Fax | 802-860-4919
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 283246
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | ME127353
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License Number State | FL
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