MEDICARE: MR. NIKOLAS CHERTUDI L.P.C.

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
1	101YP2500X	Professional Counselor	500556-6004	UT

General Provider Information

NPI Number	:	1366527343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NIKOLAS CHERTUDI L.P.C.

Provider Business Mailing Address
First Line	:	663 W HOSPITAL RD
Second Line	:
City	:	BRIGHAM CITY
State	:	UT
Zip	:	84302-3021
Country	:	US
Telephone Number	:	435-734-9449
Fax Number	:

Provider Business Practice Location Address
First Line	:	241 W 1700 N
Second Line	:
City	:	NORTH OGDEN
State	:	UT
Zip	:	84414-7265
Country	:	US
Telephone Number	:	801-388-3535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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