Individual
PAUL WENDELL NICHOLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
201 CANYON CREST DR, TWIN FALLS, ID 83301-5934
(208) 734-7362
Mailing address
201 CANYON CREST DR STE 100, TWIN FALLS, ID 83301-5935
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
69350
ID
367500000X
Certified Registered Nurse Anesthetist
8752157-4406
UT
Other
Enumeration date
02/06/2019
Last updated
12/15/2021
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