Provider Demographics
NPI:1033899505
Name:NICKELS, SAUDA M
Entity Type:Individual
Prefix:
First Name:SAUDA
Middle Name:M
Last Name:NICKELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 HARVEST GREEN CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22556-8021
Mailing Address - Country:US
Mailing Address - Phone:703-850-8209
Mailing Address - Fax:
Practice Address - Street 1:112 HARVEST GREEN CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22556-8021
Practice Address - Country:US
Practice Address - Phone:703-850-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver