Individual
MR. NICHOLAS TIEU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2434
(208) 743-2511
Mailing address
3233 COLONY HILL LN, COLUMBUS, OH 43204-2183
(847) 508-2847
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
50.005767RX
OH
363A00000X
Physician Assistant
Primary
PA1712
ID
Other
Enumeration date
12/17/2018
Last updated
02/08/2019
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