Provider Demographics
NPI:1477271591
Name:DEER, NICHOLAS WALKER (RN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:WALKER
Last Name:DEER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 CIRCULO MONTANA
Mailing Address - Street 2:
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2199
Mailing Address - Country:US
Mailing Address - Phone:858-864-0356
Mailing Address - Fax:
Practice Address - Street 1:180 CIRCULO MONTANA
Practice Address - Street 2:
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2199
Practice Address - Country:US
Practice Address - Phone:858-864-0356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ245275163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice