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NPI Code Detail

MEDICARE: MR. JAMES NICHOLS

MEDICARE: MR. JAMES NICHOLS
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1568803641
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES NICHOLS
Provider Business Mailing Address
First Line : 7101 SMOKE RANCH RD APT 2026
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-3167
Country : US
Telephone Number : 702-717-7505
Fax Number :
Provider Business Practice Location Address
First Line : 525 S 13TH ST
Second Line :
City : LAS VEGAS
State : NV
Zip : 89101-7203
Country : US
Telephone Number : 702-380-2891
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2013
Last Update Date : 07/17/2013

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Directions to “ MR. JAMES NICHOLS ” Practice Location

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