| Doctor Name: | TIMOTHY P NICKELL |
| NPI Number: | 1346516044 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | 2892-23 |
| Business Practice Address: | 265 Griffin St E Amery, WI - 540011439 |
| Business Phone Number: | 7156352151 |
| Business Fax Number: | |
| Mailing Address: | 707 Ash St, Essentia Health Spooner Clinic SPOONER |
| State: | WI |
| Postal Code: | 548011234 |
| Phone Number: | 7156352151 |
| Fax Number: | |
| NPI Enumeration Date: | 03/27/2012 |
| NPI Last Update Date: | 10/17/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2892-23 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |