| Doctor Name: | HIRUT NICODIMOS |
| NPI Number: | 1003058819 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PA06188 |
| Business Practice Address: | 302 University Blvd Round Rock, TX - 786651032 |
| Business Phone Number: | 5125090200 |
| Business Fax Number: | |
| Mailing Address: | 302 University Blvd, ROUND ROCK |
| State: | TX |
| Postal Code: | 786651032 |
| Phone Number: | 5125090200 |
| Fax Number: | |
| NPI Enumeration Date: | 03/26/2009 |
| NPI Last Update Date: | 03/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA06188 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |