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NPI Code Detail

MEDICARE: DANELLE NICK MD

MEDICARE: DANELLE NICK MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2208000000XPediatrics PhysicianMD60912797WA

General Provider Information

NPI Number : 1245556026
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANELLE NICK MD
Provider Business Mailing Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4498
Country : US
Telephone Number : 509-525-3720
Fax Number :
Provider Business Practice Location Address
First Line : 55 W TIETAN ST
Second Line :
City : WALLA WALLA
State : WA
Zip : 99362-4498
Country : US
Telephone Number : 509-525-3720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2010
Last Update Date : 01/08/2019

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Directions to “ DANELLE NICK MD” Practice Location

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