Provider Demographics
NPI:1346719507
Name:LOIS, NICHOLAS D (MMS, PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:LOIS
Suffix:
Gender:M
Credentials:MMS, PA-C
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Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3130 SQUALICUM PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1940
Mailing Address - Country:US
Mailing Address - Phone:360-671-4509
Mailing Address - Fax:
Practice Address - Street 1:3130 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1940
Practice Address - Country:US
Practice Address - Phone:360-671-4509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA56269363A00000X
WAPA61189720363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant