| Doctor Name: | JOHN NICKELS |
| NPI Number: | 1124119748 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RVT/RDMS |
| License Number: | |
| Business Practice Address: | 2474 Indian Wells Rd Alamogordo, NM - 883103831 |
| Business Phone Number: | 5054430339 |
| Business Fax Number: | |
| Mailing Address: | Po Box 247, ALAMOGORDO |
| State: | NM |
| Postal Code: | 883110247 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/27/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471V0105X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Vascular Sonography |
| Taxonomy Definition: | |