Provider Demographics
NPI:1679021067
Name:STUCKI, NICHOLAS EARL (APRN)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:EARL
Last Name:STUCKI
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E RIVERSIDE DR STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8722
Mailing Address - Country:US
Mailing Address - Phone:435-216-7000
Mailing Address - Fax:425-216-7001
Practice Address - Street 1:617 E RIVERSIDE DR STE 301
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8722
Practice Address - Country:US
Practice Address - Phone:435-216-7000
Practice Address - Fax:425-216-7001
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8270876-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner