MEDICARE: NICHOLAS JAMES DAYTON

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	101Y00000X	Counselor		NV

General Provider Information

NPI Number	:	1629687538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS JAMES DAYTON

Provider Business Mailing Address
First Line	:	2038 PALM ST SPC 78
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4833
Country	:	US
Telephone Number	:	253-298-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	2038 PALM ST SPC 78
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-4833
Country	:	US
Telephone Number	:	253-298-0142
Fax Number	:

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

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	07/27/2020

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