Individual
DANIEL LEE NICOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 E 13TH ST, SUITE C, GROVE, OK 74344-2989
(918) 786-7878
(918) 786-7884
Mailing address
5300 N INDEPENDENCE AVE, SUITE 280, OKLAHOMA CITY, OK 73112-5556
(918) 786-7878
(918) 786-7884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3684
OK
207VX0000X
Obstetrics Physician
3684
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100185810C
—
OK
01
—
800522535
MEDICARE GROUP PIN
OK
Enumeration date
01/27/2006
Last updated
04/05/2017
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