| Doctor Name: | MARY SUE NICHOLSON |
| NPI Number: | 1063662849 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CRNP |
| License Number: | SP007470 |
| Business Practice Address: | 4098 Edgmont Ave Brookhaven, PA - 190152211 |
| Business Phone Number: | 8668253227 |
| Business Fax Number: | 4844502617 |
| Mailing Address: | 161 Washington St, Eight Tower Bridge Ste 1400 CONSHOHOCKEN |
| State: | PA |
| Postal Code: | 194282083 |
| Phone Number: | 8668253227 |
| Fax Number: | 4844502617 |
| NPI Enumeration Date: | 09/29/2008 |
| NPI Last Update Date: | 09/29/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | SP007470 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |