Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 58.003060 | OH |
Y | 207VX0000X | Obstetrician | OP60274656 | WA |
NPI | 1053604819 |
---|---|
Provider Name | Adam Todd Nickel |
First Address | Tacoma, WA 98403-1984 |
Second Address | Tacoma, WA 98403-1984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 07/09/2012 |