Provider Demographics
NPI:1598313843
Name:WILLS, NICHOLAS PETER ALPHONSO (BC-HIS)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PETER ALPHONSO
Last Name:WILLS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297C BRITTANY FARMS RD # RS
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1111
Mailing Address - Country:US
Mailing Address - Phone:860-904-0414
Mailing Address - Fax:
Practice Address - Street 1:297 BRITTANY FARMS RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1124
Practice Address - Country:US
Practice Address - Phone:860-904-0414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT393237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist