MEDICARE: ARTHANDREALE NICHOLAS FNP

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	363LF0000X	Family Nurse Practitioner	RN225186	GA

General Provider Information

NPI Number	:	1629554951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARTHANDREALE NICHOLAS FNP

Provider Business Mailing Address
First Line	:	2414 COUNTY ROAD 90 APT 624
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-5115
Country	:	US
Telephone Number	:	601-868-0951
Fax Number	:

Provider Business Practice Location Address
First Line	:	98 COHEN WALKER DR
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-2729
Country	:	US
Telephone Number	:	478-218-2000
Fax Number	:

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

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/19/2018

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