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General NPI Number Information
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NPI Number | 1659582724
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Entity Type | Individual
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Provider Name | JENNIFER LYNN NICHOLS DO
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 04/22/2008
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Provider Practice Location Address
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Address Line | 100 N ACADEMY AVE 29-20
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City | DANVILLE
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State | PA
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Zip | 17822-9800
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Country | US
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Telephone | 570-271-6296
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Fax | 570-271-5819
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Provider Business Mailing Address
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Address Line | 100 N ACADEMY AVE 29-20
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City | DANVILLE
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State | PA
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Zip | 17822-9800
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Country | US
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Telephone | 570-271-6296
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Fax | 570-271-5819
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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 | 207VX0000X
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Taxonomy Name | Obstetrics
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License Number | 5101015722
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology
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License Number | OS014387
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License Number State | PA
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