Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 12119 | ND |
N | 208800000X | Urologist | 21482 | MS |
N | 208800000X | Urologist | 49436 | MN |
NPI | 1063619237 |
---|---|
Provider Name | Adam Foster Nicholson |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 24/09/2020 |