Individual
NICHOLAS ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3200 CHANNING WAY STE 206, IDAHO FALLS, ID 83404-7546
(208) 529-2230
(208) 453-6142
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1788
ID
Other
Enumeration date
10/17/2018
Last updated
06/04/2024
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