Provider Demographics
NPI:1679668297
Name:NICHOLSON, KAREN D (MD, MPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10885 SANDY HOOK RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2521
Mailing Address - Country:US
Mailing Address - Phone:858-586-0846
Mailing Address - Fax:
Practice Address - Street 1:333 S. TWIN OAKS VALLEY RD
Practice Address - Street 2:CAL STATE SAN MARCOS SHCS
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92096-0001
Practice Address - Country:US
Practice Address - Phone:760-750-4920
Practice Address - Fax:760-750-3181
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG748562083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine