Individual
TIMOTHY STEVEN NICOLELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1109 W MYRTLE ST, SUITE 200, BOISE, ID 83702-6970
(208) 874-3449
Mailing address
14078 W BUNKERHILL ST, BOISE, ID 83713-0702
(208) 874-3449
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
400
ID
246Z00000X
Other Specialist/Technologist
—
ID
Other
Enumeration date
10/31/2011
Last updated
04/02/2012
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