Individual
NICHOLAS WIILLIAM WINN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
330 N MAIN ST, ABERDEEN, ID 83210
(208) 397-4126
Mailing address
555 SNOWFLAKE ST, AMERICAN FALLS, ID 83211-1178
(435) 994-9993
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1535
ID
Other
Enumeration date
10/02/2017
Last updated
10/02/2017
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