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General NPI Number Information
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NPI Number | 1942270004
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Entity Type | Individual
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Provider Name | KENT A NICKELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 1825 LOGAN AVE NORTHEAST IOWA PATHOLOGY ASSOCIATES,PC
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City | WATERLOO
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State | IA
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Zip | 50703-1916
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Country | US
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Telephone | 319-235-3679
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Fax | 319-233-0722
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Provider Business Mailing Address
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Address Line | 2400 N ROCKTON AVE MERCYHEALTH- ROCKFORD HEALTH PHYSICIANS
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City | ROCKFORD
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State | IL
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Zip | 61103-3655
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Country | US
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Telephone | 815-971-5000
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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 | 207ZP0101X
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Taxonomy Name | Anatomic Pathology Physician
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License Number | 32811
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207ZC0500X
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Taxonomy Name | Cytopathology Physician
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License Number | 036148445
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License Number State | IL
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