Provider Demographics
NPI:1326238502
Name:NICHOLLS, LAUREN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANNE
Last Name:NICHOLLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 245073, 1501 N. CAMPBELL AVE.
Mailing Address - Street 2:RM 5341C BANNER UNIVERSITY MEDICAL CENTER-TUCSON
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5073
Mailing Address - Country:US
Mailing Address - Phone:520-626-6040
Mailing Address - Fax:
Practice Address - Street 1:1501 N. CAMPBELL AVE.
Practice Address - Street 2:RM 5341C BANNER UNIVERSITY MEDICAL CENTER-TUCSON
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5073
Practice Address - Country:US
Practice Address - Phone:520-626-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics