Healthcare Provider Details

I. General information

NPI: 1265819452
Provider Name (Legal Business Name): CATHERINE M NICKA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 BRUCE ST
YREKA CA
96097-3450
US

IV. Provider business mailing address

444 BRUCE ST
YREKA CA
96097-3450
US

V. Phone/Fax

Practice location:
  • Phone: 308-424-1215
  • Fax:
Mailing address:
  • Phone: 530-842-4121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD2018-0977
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA171729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: