Individual provider · Type 1 NPI
Mary Sue Nicholson, CRNP
Family Nurse Practitioner · Brookhaven, PA
NPI number
1063662849
Active
Practice location
4098 Edgmont Ave
Brookhaven, PA 19015-2211
Fax (484) 450-2617
Mailing address
161 Washington St, Eight Tower Bridge Ste 1400
Conshohocken, PA 19428-2083
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Family Nurse Practitioner Primary | 363LF0000X | SP007470 (PA) |
Family Nurse Practitioner: Definition to come...
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About NPI 1063662849
Mary Sue Nicholson, CRNP's National Provider Identifier is 1063662849, issued on Sep 29, 2008. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Brookhaven, PA. The record was last updated on Sep 29, 2008.