| NPI | 1053312801 | 
|---|---|
| Former Name | DANA NICHOLS | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP0287) | 
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ AP287) | 
| Enumeration Date | 2005-08-02 | 
| Last Update Date | 2020-05-22 |