Individual
RUSSELL NICOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
6501 E GREENWAY PKWY, SCOTTSDALE, AZ 85254-2065
(480) 948-3314
(480) 948-3588
Mailing address
1250 S CLEARVIEW AVE STE 100, MESA, AZ 85209-3378
(480) 988-9108
(480) 813-4460
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2565
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
711962
—
AZ
Enumeration date
05/23/2006
Last updated
04/16/2015
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