Provider Demographics
NPI:1508142167
Name:NICHOLS, DARYL W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DARYL
Middle Name:W
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4326 E ORCHID LN
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-9675
Mailing Address - Country:US
Mailing Address - Phone:480-202-8285
Mailing Address - Fax:
Practice Address - Street 1:4326 E ORCHID LN
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-9675
Practice Address - Country:US
Practice Address - Phone:480-202-8285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA0799367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered