Provider Demographics
NPI:1578865622
Name:NIKKEL, TIMOTHY DEAN
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:DEAN
Last Name:NIKKEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:TIM
Other - Middle Name:DEAN
Other - Last Name:NIKKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5011 MORNINGSIDE AVE.
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-3027
Mailing Address - Country:US
Mailing Address - Phone:712-224-4722
Mailing Address - Fax:186-635-8636
Practice Address - Street 1:5011 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-3027
Practice Address - Country:US
Practice Address - Phone:712-224-4722
Practice Address - Fax:186-635-8636
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA882ZZ1895343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)