Individual
NICHOLAS GURGANIOUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1304 FRANKLIN AVE, NORMAL, IL 61761-3558
(253) 820-4337
Mailing address
1423 E OLIVE ST, BLOOMINGTON, IL 61701-5709
(253) 820-4337
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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