| NPI | 1871528323 |
|---|---|
| Former Name | CHRISTINA DIANE NICKELL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: KS 15-01079) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MO 2007030789) |
| 363AS0400X Physician Assistant, Surgical (Licence: KS 15-01079) | |
| 363AS0400X Physician Assistant, Surgical (Licence: MO 2007030789) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-01-19 |