Doctor Name: | MR. JAMES H NICELY |
NPI Number: | 1073614236 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 123 |
Business Practice Address: | 1001 Mountain St Suite 3 M Carson City, NV - 897033822 |
Business Phone Number: | 7758858890 |
Business Fax Number: | 7758858865 |
Mailing Address: | 1001 Mountain St, Suite 3 M CARSON CITY |
State: | NV |
Postal Code: | 897033822 |
Phone Number: | 7758858890 |
Fax Number: | 7758858865 |
NPI Enumeration Date: | 09/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 123 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NV |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |