Provider Demographics
NPI:1215456991
Name:NICHOLSON, CLAIRE ELIZABETH (PA-C)
Entity type:Individual
Prefix:MS
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30300 TELEGRAPH RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:248-569-3704
Practice Address - Street 1:30300 TELEGRAPH RD STE 310
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-5822
Practice Address - Country:US
Practice Address - Phone:248-468-1889
Practice Address - Fax:248-419-2453
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601008397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601008397OtherNCCPA