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General NPI Number Information
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NPI Number | 1679669808
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Entity Type | Organization
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Legal Business Name | LAKE MARY OB/GYN
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2500 W LAKE MARY BLVD SUITE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-323-2727
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Fax | 407-323-2771
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Provider Business Mailing Address
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Address Line | 2500 W LAKE MARY BLVD SUITE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-3501
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Country | US
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Telephone | 407-323-2727
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Fax | 407-323-2771
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Authorized Official
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Title or Position | DO
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Name | ERIKA NICHELSON
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Credential | DO
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Telephone | 407-323-2727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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