| NPI | 1255702429 |
|---|---|
| Former Name | STEPHANIE DAWN NICHOLS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-76991) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2015036519) |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2023-04-21 |