Individual
STEPHEN NICHOLLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 NE MOTHER JOSEPH PL, SUITE 330, VANCOUVER, WA 98664-3299
(360) 514-1854
(360) 514-6063
Mailing address
600 BROADWAY 112, SEATTLE, WA 98122-5381
(206) 420-3119
(206) 453-5912
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
23966
WA
2086S0129X
Vascular Surgery Physician
Primary
MD00023966
WA
2086S0129X
Vascular Surgery Physician
MD03825IL
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8105322
—
WA
Enumeration date
06/29/2006
Last updated
09/30/2016
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