Provider Demographics
NPI:1871714824
Name:NICHOLAS, CHRISTINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:NICHOLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3243 E MURDOCK ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3052
Mailing Address - Country:US
Mailing Address - Phone:316-685-6222
Mailing Address - Fax:316-685-1273
Practice Address - Street 1:3243 E MURDOCK ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3052
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6352208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200663440AMedicaid
KS016633002OtherMEDICARE