Provider Demographics
NPI:1750499711
Name:NICHELSON, ERIKA L (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:L
Last Name:NICHELSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ERIKA
Other - Middle Name:L
Other - Last Name:TUDOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:20 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2275
Mailing Address - Country:US
Mailing Address - Phone:717-637-7755
Mailing Address - Fax:717-637-7142
Practice Address - Street 1:20 NORTH ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2275
Practice Address - Country:US
Practice Address - Phone:717-637-7755
Practice Address - Fax:717-637-7142
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDO61853207V00000X
PAOS021824207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD051027100Medicaid