| Doctor Name: | MRS. JILL CAROLYN NICHOLSON |
| NPI Number: | 1649558479 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | AP30005742 |
| Business Practice Address: | 1339 Alameda Ave Fircrest, WA - 984666552 |
| Business Phone Number: | 2535647701 |
| Business Fax Number: | 2535654688 |
| Mailing Address: | 1339 Alameda Ave, FIRCREST |
| State: | WA |
| Postal Code: | 984666552 |
| Phone Number: | 2535647701 |
| Fax Number: | 2535654688 |
| NPI Enumeration Date: | 07/27/2011 |
| NPI Last Update Date: | 07/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP30005742 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |