Individual
TIMOTHY P NICKELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
331 S MAIN ST, RICE LAKE, WI 54868-2253
(715) 236-8500
Mailing address
200 1ST ST SW, ROCHESTER, MN 55905-0001
(715) 838-5222
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2892
WI
363AM0700X
Medical Physician Assistant
2892-23
WI
Other
Enumeration date
03/27/2012
Last updated
02/03/2021
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