Healthcare Provider Details

I. General information

NPI: 1497021935
Provider Name (Legal Business Name): NICHOLAS ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 COLBY JEAN RD
CHATHAM LA
71226-9788
US

IV. Provider business mailing address

466 COLBY JEAN RD
CHATHAM LA
71226-9788
US

V. Phone/Fax

Practice location:
  • Phone: 318-737-9814
  • Fax:
Mailing address:
  • Phone: 318-737-9814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06778
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9341335
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28218373A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: