Individual
TIMOTHY ROBERT NICKOLAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
875 SWIFT BLVD, RICHLAND, WA 99352-3592
(509) 946-1654
(509) 943-5652
Mailing address
560 GAGE BLVD, SUITE 203, RICHLAND, WA 99352
(509) 942-3627
(509) 942-2268
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60217353
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518250554
—
WA
Enumeration date
05/24/2011
Last updated
06/22/2021
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