Individual
NIKOLAS SHANE WAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNAP, CRNA
Contact information
Practice address
8401 PAN AMERICAN FWY NE UNIT 156A, ALBUQUERQUE, NM 87113-1824
(405) 420-2219
Mailing address
801 N MINGO RD TRLR 106, TULSA, OK 74116-5639
(405) 420-2219
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R0128863
OK
367500000X
Certified Registered Nurse Anesthetist
Primary
84604
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/02/2025
Last updated
08/27/2025
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