| Doctor Name: | DR. AMY JO NICHOLS |
| NPI Number: | 1487807814 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 010 671 22A |
| Business Practice Address: | 400 Russell Ave Bldg 41 Nbhc Belle Chasse New Orleans, LA - 701435077 |
| Business Phone Number: | 5046787908 |
| Business Fax Number: | |
| Mailing Address: | 820 W G St Apt 132, SAN DIEGO |
| State: | CA |
| Postal Code: | 921015936 |
| Phone Number: | 9176966582 |
| Fax Number: | |
| NPI Enumeration Date: | 10/29/2008 |
| NPI Last Update Date: | 12/13/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 010 671 22A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |