Provider Demographics
NPI:1154429520
Name:NICKEL, LOWELL D (MD)
Entity type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:D
Last Name:NICKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 OLIVE HWY
Mailing Address - Street 2:SUITE #230
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6131
Mailing Address - Country:US
Mailing Address - Phone:530-533-5044
Mailing Address - Fax:530-533-5221
Practice Address - Street 1:2809 OLIVE HWY
Practice Address - Street 2:SUITE #230
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6131
Practice Address - Country:US
Practice Address - Phone:530-533-5044
Practice Address - Fax:530-533-5221
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46716174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50470Medicare UPIN