Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 35096239 | OH |
N | 208800000X | Urologist | 4301090624 | MI |
NPI | 1033223318 |
---|---|
Provider Name | Craig Alan Nicholson |
First Address | Miamisburg, OH 45342-6115 |
Second Address | Wapakoneta, OH 45895-9775 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I12635 | (02) | MI |