Provider Demographics
NPI:1598592891
Name:NICKLES, ANTHONY
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NICKLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 DREW RD
Mailing Address - Street 2:
Mailing Address - City:ARCANUM
Mailing Address - State:OH
Mailing Address - Zip Code:45304-9730
Mailing Address - Country:US
Mailing Address - Phone:937-974-5057
Mailing Address - Fax:
Practice Address - Street 1:3849 DREW RD
Practice Address - Street 2:
Practice Address - City:ARCANUM
Practice Address - State:OH
Practice Address - Zip Code:45304-9730
Practice Address - Country:US
Practice Address - Phone:937-974-5057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide