MEDICARE: NICHOLAS A. TENNEY

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
1	246ZS0410X	Surgical Technologist	171363	CA
2	246ZC0007X	Surgical Assistant
3	246ZS0410X	Surgical Technologist	171363

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	171363	OTHER		NBSTSA

General Provider Information

NPI Number	:	1932568391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS A. TENNEY

Provider Business Mailing Address
First Line	:	PO BOX 570892
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89157-0892
Country	:	US
Telephone Number	:	323-487-1652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3433 ALGIERS DR APT 2192
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2848
Country	:	US
Telephone Number	:	702-823-6207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2016
Last Update Date	:	01/17/2023

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Directions to “ NICHOLAS A. TENNEY ” Practice Location

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