| Doctor Name: | NICHOLAS EMILE FERNANDO |
| NPI Number: | 1023010162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 0401 |
| Business Practice Address: | 101 Tower Rd Suite 103 Dakota Dunes, SD - 570495007 |
| Business Phone Number: | 6052177246 |
| Business Fax Number: | 6052174878 |
| Mailing Address: | 917 Wynstone Rd, JEFFERSON |
| State: | SD |
| Postal Code: | 570386875 |
| Phone Number: | 6054223102 |
| Fax Number: | 6054223103 |
| NPI Enumeration Date: | 06/01/2005 |
| NPI Last Update Date: | 07/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 0401 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SD |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |