Individual
CHRISTOPHER ALAN ANTHONY NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3101 E STATE ST, EAGLE, ID 83616-6232
(208) 473-3100
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 375-0599
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
66285
ID
Other
Enumeration date
11/05/2020
Last updated
01/18/2023
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