Healthcare Provider Details

I. General information

NPI: 1144679937
Provider Name (Legal Business Name): NICHOLAS ADRIAN NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 N LAKEMAN DR
BELLBROOK OH
45305-1239
US

IV. Provider business mailing address

1930 N LAKEMAN DR
BELLBROOK OH
45305-1239
US

V. Phone/Fax

Practice location:
  • Phone: 937-203-3079
  • Fax: 937-886-6609
Mailing address:
  • Phone: 937-203-3079
  • Fax: 937-886-6609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.19201
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: