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Individual

DR. JONATHAN MATTHEW NICKOLOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D,

Contact information

Practice address
9922 N NEVADA ST, SPOKANE, WA 99218-1126
(509) 747-6194
(509) 838-0824
Mailing address
PO BOX 421, LIBERTY LAKE, WA 99019-0421
(866) 747-2455
(509) 227-7070

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD00044271
WA
208C00000X
Colon & Rectal Surgery Physician
MD00044271
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
8449159
WA
Enumeration date
05/27/2006
Last updated
11/29/2022
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