Individual
DR. NICHOLAS WADE STULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3421 W 9TH ST, WATERLOO, IA 50702-5401
(319) 272-8000
(319) 272-7313
Mailing address
3421 W 9TH ST, WATERLOO, IA 50702-5401
(231) 313-1702
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101021742
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315070508
CONTROLLED SUBSTANCE LICENSE
MI
Enumeration date
04/19/2015
Last updated
07/24/2023
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