MEDICARE: NICHOLAS GILES PSYD

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	103T00000X	Psychologist	372	NE

General Provider Information

NPI Number	:	1568615169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GILES PSYD

Provider Business Mailing Address
First Line	:	1550 S 70TH ST
Second Line	:	SUITE 101
City	:	LINCOLN
State	:	NE
Zip	:	68506-1576
Country	:	US
Telephone Number	:	402-488-0077
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 S 70TH ST
Second Line	:	SUITE 101
City	:	LINCOLN
State	:	NE
Zip	:	68506-1576
Country	:	US
Telephone Number	:	402-488-0077
Fax Number	:

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	09/16/2024

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