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NPI Code Detail

MEDICARE: TOMMY D NIGBOR PA-C

MEDICARE: TOMMY D NIGBOR PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant708WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154346518
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOMMY D NIGBOR PA-C
Provider Business Mailing Address
First Line : 15954 RIVERS EDGE DR
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7800
Country : US
Telephone Number : 715-634-2541
Fax Number : 715-634-5740
Provider Business Practice Location Address
First Line : 15954 RIVERS EDGE DR
Second Line :
City : HAYWARD
State : WI
Zip : 54843-7800
Country : US
Telephone Number : 715-634-2541
Fax Number : 715-634-5740
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 05/18/2021

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Directions to “ TOMMY D NIGBOR PA-C” Practice Location

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