Provider Demographics
NPI:1821617192
Name:BUCHHOLZ, NICHOLAUS BRANT
Entity Type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:BRANT
Last Name:BUCHHOLZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 ENTERPRISE RD APT 612
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1678
Mailing Address - Country:US
Mailing Address - Phone:775-339-1310
Mailing Address - Fax:
Practice Address - Street 1:2800 ENTERPRISE RD APT 612
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1678
Practice Address - Country:US
Practice Address - Phone:775-339-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV999999999999999993747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider