Provider Demographics
NPI:1548499924
Name:NICHOLS, PAUL LAWRENCE JR (BMET)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:LAWRENCE
Last Name:NICHOLS
Suffix:JR
Gender:M
Credentials:BMET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-1019
Mailing Address - Country:US
Mailing Address - Phone:406-495-1060
Mailing Address - Fax:406-495-1060
Practice Address - Street 1:1424 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-1019
Practice Address - Country:US
Practice Address - Phone:406-495-1060
Practice Address - Fax:406-495-1060
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT599710332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies