# LWN MEDICAL PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073894598
- **Authorized official:** LARRY W NICHOLS MD (OWNER)
- **Authorized official phone:** (928) 537-7011

## Contact information

- **Practice address:** 3401 LOCKWOOD DR, LAKESIDE, AZ 85929-5613
- **Practice address phone:** (928) 368-2060
- **Mailing address:** 1600 S WHITE MOUNTAIN RD, SHOW LOW, AZ 85901-7106
- **Mailing address phone:** (928) 537-7011

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 14326 | AZ | Yes |

## Other

- **Enumeration date:** 08/30/2011
- **Last updated:** 08/30/2011