Individual
NICHOLAS HASANDRAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-2115
Mailing address
1415 E KINCAID ST, MOUNT VERNON, WA 98274-4126
(360) 814-2115
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
78149
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/09/2016
Last updated
11/07/2019
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