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JUSTIN NICHOLS RN

Nursing Service Providers Registered Nurse Emergency

Provider NPI: 1427562123

Provider Information:
 JUSTIN  NICHOLS RN
Gender: M
Not Sole Proprietor

Practice Location:
24276 AIRPORT RD  EAGLE BUTTE, SD 57625-5762 US
Tel: 608-964-7724  Fax: 816-668-4516

Business Mailing Address:
PO BOX 51  EAGLE BUTTE, SD 57625-0051 US
Tel: 816-668-4516  Fax: --

NPI Information:
NPI: 1427562123
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y163WE0003XNursing Service Providers
Registered Nurse
Emergency
MO2013025569

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 163WE0003X

Type:

Classification:



Definition:



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