Healthcare Provider Details

I. General information

NPI: 1699262378
Provider Name (Legal Business Name): NICHOLAS JAMES BRICE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3916 N INTERTECH CT
APPLETON WI
54913-6957
US

IV. Provider business mailing address

3916 N INTERTECH CT
APPLETON WI
54913-6957
US

V. Phone/Fax

Practice location:
  • Phone: 920-996-1000
  • Fax: 920-996-1054
Mailing address:
  • Phone: 920-996-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8750-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: