Dr. Sandra Bruce Nichols, md
Health Maintenance Organization in Reston, VA. Individual provider (NPI-1).
NPI number1780967232
StatusActive
Last updated in NPPESSep 21, 2011
Details
- NPI
- 1780967232
- Entity type
- Individual (NPI-1)
- Name
- Dr. Sandra Bruce Nichols
- Credential
- md
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Sep 21, 2011
- Last updated
- Sep 21, 2011
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 302R00000X | Health Maintenance Organization | D60180 | MD | Yes |
| 207Q00000X | Family Medicine | D60180 | MD |
Other names
- Sandra Denise Nichols (Professional Name)
Practice location
12018 Sunrise Valley DrSuite 400
Reston, VA 20191-3432
Phone 301-448-6550
Mailing address
12706 Young LnNorth Potomac, MD 20878-6112
Phone 301-947-6774 · Fax 131-094-7677
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