Provider Demographics
NPI:1962204560
Name:HOUSAND, NICHOLAS JAMES (SOIDC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JAMES
Last Name:HOUSAND
Suffix:
Gender:
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 INVERNESS DR
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539-4601
Mailing Address - Country:US
Mailing Address - Phone:540-841-9353
Mailing Address - Fax:
Practice Address - Street 1:2ND RECON BLDG A-71 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:AA
Practice Address - Zip Code:28547
Practice Address - Country:US
Practice Address - Phone:910-376-7423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman