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NPI Code Detail

MEDICARE: DR. BREANNA EIDSON NICHOLS DO

MEDICARE: DR. BREANNA EIDSON NICHOLS DO
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
1171000000XMilitary Health Care Provider

General Provider Information

NPI Number : 1609664846
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BREANNA EIDSON NICHOLS DO
Provider Business Mailing Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Provider Business Practice Location Address
First Line : 4700 LAS VEGAS BLVD N
Second Line :
City : NELLIS AFB
State : NV
Zip : 89191-6600
Country : US
Telephone Number : 702-653-2273
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2025
Last Update Date : 05/15/2026

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