Provider Demographics
NPI:1699050617
Name:NICHOLLS, DAN ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:ARTHUR
Last Name:NICHOLLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:984150 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-4150
Mailing Address - Country:US
Mailing Address - Phone:402-559-7353
Mailing Address - Fax:402-559-7372
Practice Address - Street 1:984150 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-4150
Practice Address - Country:US
Practice Address - Phone:402-559-7353
Practice Address - Fax:402-559-7372
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8916390200000X
WY532363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant