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General NPI Number Information
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NPI Number | 1114906252
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Entity Type | Individual
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Provider Name | JOHN M NICHOLS MD
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Gender | Male
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 9850 W ST LUKES DR
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City | NAMPA
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State | ID
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Zip | 83687-7912
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Country | US
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Telephone | 208-381-2267
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Fax | 208-381-4314
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Provider Business Mailing Address
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Address Line | 190 E BANNOCK ST
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City | BOISE
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State | ID
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Zip | 83712-6241
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5111807-1204
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 511807-1204
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 6371542
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License Number State | ID
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