Provider Demographics
NPI:1699101972
Name:NICHOLS, JULIE ANNE (MED, CALT/LDT)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:MED, CALT/LDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16765 LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:TX
Mailing Address - Zip Code:78154-3809
Mailing Address - Country:US
Mailing Address - Phone:210-656-2999
Mailing Address - Fax:
Practice Address - Street 1:15107 COG HL
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:TX
Practice Address - Zip Code:78154-1327
Practice Address - Country:US
Practice Address - Phone:210-459-0641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist