Healthcare Provider Details

I. General information

NPI: 1306248901
Provider Name (Legal Business Name): DAVID AARON NICHOLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 01/31/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 W CHEYENNE AVE
N LAS VEGAS NV
89032-2484
US

IV. Provider business mailing address

4071 SPARROW ROCK ST
LAS VEGAS NV
89129-3286
US

V. Phone/Fax

Practice location:
  • Phone: 702-675-6314
  • Fax:
Mailing address:
  • Phone: 702-538-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1602760796
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: