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General NPI Number Information
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NPI Number | 1518962091
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Entity Type | Individual
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Provider Name | WILLIAM NICHOLS DPM
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Gender | Male
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 02/18/2013
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Provider Practice Location Address
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Address Line | 12940 HARRIET AVE S
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City | BURNSVILLE
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State | MN
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Zip | 55337-2680
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Country | US
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Telephone | 952-830-4061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 426
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City | SAINT FRANCIS
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State | MN
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Zip | 55070-0426
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Country | US
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Telephone | 763-444-4111
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Fax | 763-444-4488
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 360
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 360
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License Number State | MN
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