Individual
RICKY ANTHONY NICOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
417 SE 164TH AVE, SUITE 300, VANCOUVER, WA 98684-8943
(360) 896-6944
(360) 254-2894
Mailing address
PO BOX 92900, PORTLAND, OR 97292-0900
(360) 896-6944
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30591
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8144925
—
WA
Enumeration date
11/23/2005
Last updated
09/03/2014
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