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General NPI Number Information
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NPI Number | 1497946693
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Entity Type | Individual
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Provider Name | NICHOLAS DOTSON PMHNP
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 912 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 312-996-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 912 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60612-4300
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Country | US
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Telephone | 129-962-2003
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209018300
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.000715
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.018300
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License Number State | IL
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