Provider Demographics
NPI:1356366819
Name:NICHOLSON, CARRIE B (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:B
Last Name:NICHOLSON
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 1:302 N MONROE ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1765
Mailing Address - Country:US
Mailing Address - Phone:517-629-2134
Mailing Address - Fax:
Practice Address - Street 1:302 N MONROE ST STE A
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1765
Practice Address - Country:US
Practice Address - Phone:517-629-2134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICN083244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MICN083244OtherSTATE MEDICAL LICENSE