Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 56208 | MN |
N | 207K00000X | Allergist & Immunologist | MD53016 | TN |
N | 207R00000X | Internist | 125055926 | IL |
N | 111NI0900X | Internist | 125055926 | IL |
N | 207R00000X | Internist | MD53016 | TN |
N | 111NI0900X | Internist | MD53016 | TN |
N | 208000000X | Pediatrician | 125055926 | IL |
N | 208000000X | Pediatrician | 53016 | TN |
N | 208000000X | Pediatrician | 56208 | MN |
N | 2080P0201X | Pediatric Allergist | 53016 | TN |
NPI | 1922230101 |
---|---|
Provider Name | Dr. Andrew Nickels |
First Address | Minneapolis, MN 55440-1309 |
Second Address | Burnsville, MN 55337-5713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 17/03/2018 |