Individual
JEFFREY R. NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 MINERAL POINT AVE, JANESVILLE, WI 53548
(608) 756-6611
(608) 756-6177
Mailing address
1000 MINERAL POINT AVE, JANESVILLE, WI 53548-2940
(608) 756-6611
(608) 756-6177
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-144477
IL
207P00000X
Emergency Medicine Physician
Primary
69172-21
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316334683
BCBSWI
WI
05
—
1316334683
—
WI
01
—
4919
MERCYCARE INSURANCE
WI
01
—
K400494086
WI MEDICARE
WI
Enumeration date
04/23/2015
Last updated
09/12/2018
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