Individual
MR. NICHOLAS L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
130 2ND ST, NEENAH, WI 54956-2883
(920) 969-7906
(920) 969-7979
Mailing address
130 2ND ST, NEENAH, WI 54956-2883
(920) 969-7906
(920) 969-7979
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
73724-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366976409
—
WI
Enumeration date
04/15/2017
Last updated
07/31/2020
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