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1548366347

NPI Code Detail

MEDICARE: ALVIN KIRK NICHOLS CRNA

MEDICARE: ALVIN KIRK NICHOLS CRNA

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	367500000X	Certified Registered Nurse Anesthetist	3319524406	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16311	OTHER	UT	HEALTHY U
2	33195244000001	OTHER	UT	BCBS
3	68308	OTHER	UT	PEHP
4	190683600	OTHER	UT	US DEPT OF LABOR
5	740685	OTHER	UT	DESERET MUTUAL
6	PRA07054	OTHER	UT	MOLINA
7	870666269NIC	OTHER	UT	EDUCATORS MUTUAL
8	107011533101	OTHER	UT	IHC
9	QM0000054865	OTHER	UT	ALTIUS

General Provider Information

NPI Number	:	1548366347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVIN KIRK NICHOLS CRNA

Provider Business Mailing Address
First Line	:	1954 FORT UNION BLVD
Second Line	:	STE 114
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6899
Country	:	US
Telephone Number	:	800-594-5736
Fax Number	:

Provider Business Practice Location Address
First Line	:	1954 FORT UNION BLVD
Second Line	:	STE 114
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-6899
Country	:	US
Telephone Number	:	800-594-5736
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	09/06/2022

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Practice Location Address:

1954 FORT UNION BLVD STE 114
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84121-6899

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Practice Fax:

1720184542 — ROBERT D STEED CRNA
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84121-6899

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1013013838 — MATTHEW S ADAMS CRNA
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1437255288 — BRYAN G WRIGHT CRNA
Practice Location Address:

1954 FORT UNION BLVD STE 114
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1447356217 — ALAN N HOWE CRNA
Practice Location Address:

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SALT LAKE CITY, UT
84121-6899

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Practice Fax:

1124124961 — MICHAEL J SLYE CRNA
Practice Location Address:

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84121-6899

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Directions to “ ALVIN KIRK NICHOLS CRNA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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