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General NPI Number Information
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NPI Number | 1467039370
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Entity Type | Individual
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Provider Name | JASON NIKOUYEH
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Gender | Male
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Dates
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Enumeration Date | 03/26/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 807 4TH ST SW
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City | CONOVER
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State | NC
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Zip | 28613-2638
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Country | US
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Telephone | 828-464-3715
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Fax |
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Provider Business Mailing Address
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Address Line | 282 N EMILY CT
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City | HIGH POINT
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State | NC
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Zip | 27265-7666
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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 | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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