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General NPI Number Information
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NPI Number | 1568818458
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Entity Type | Individual
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Provider Name | MICHAEL NICHOLS
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Gender | Male
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 114 W CHERYL ST
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City | OSCEOLA
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State | AR
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Zip | 72370-2837
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Country | US
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Telephone | 870-622-0073
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Fax | 870-622-0071
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Provider Business Mailing Address
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Address Line | 114 W CHERYL ST
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City | OSCEOLA
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State | AR
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Zip | 72370-2837
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Country | US
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Telephone | 870-622-0073
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Fax | 870-622-0071
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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