Provider Demographics
NPI:1730672866
Name:NICOLA, MARCUS (NP)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:NICOLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 204E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7502
Mailing Address - Country:US
Mailing Address - Phone:406-237-5001
Mailing Address - Fax:406-237-5010
Practice Address - Street 1:2900 12TH AVE N STE 204E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-237-5001
Practice Address - Fax:406-237-5010
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT131767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner