Basic Information
| Provider Information | |||||||||
| NPI: | 1083118939 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 IRVING ST NW BLDG 3124 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200103017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028777000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 IRVING ST NW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200103017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106134475 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2018 | ||||||||
| LastUpdateDate: | 12/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | D0091640 | MD | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD049405 | DC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.