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General NPI Number Information
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NPI Number | 1548366347
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Entity Type | Individual
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Provider Name | ALVIN KIRK NICHOLS CRNA
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Gender | Male
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 1954 FORT UNION BLVD STE 114
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6899
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Country | US
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Telephone | 800-594-5736
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Fax |
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Provider Business Mailing Address
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Address Line | 1954 FORT UNION BLVD STE 114
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City | SALT LAKE CITY
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State | UT
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Zip | 84121-6899
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Country | US
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Telephone | 800-594-5736
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 3319524406
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License Number State | UT
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