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NPI Code Detail

MEDICARE: JENNIFER NICHOLS

MEDICARE: JENNIFER NICHOLS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1972924702
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER NICHOLS
Provider Business Mailing Address
First Line : 669 W 34TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-0067
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 669 W 34TH ST
Second Line :
City : LOS ANGELES
State : CA
Zip : 90089-0067
Country : US
Telephone Number : 213-740-0545
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2013
Last Update Date : 12/05/2014

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