Provider Demographics
NPI:1851011100
Name:ARTHERHULTS, NICKOLAS (PR)
Entity Type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:
Last Name:ARTHERHULTS
Suffix:
Gender:M
Credentials:PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 8TH AVE W
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2510
Mailing Address - Country:US
Mailing Address - Phone:681-888-5291
Mailing Address - Fax:
Practice Address - Street 1:137 8TH AVE W
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2510
Practice Address - Country:US
Practice Address - Phone:681-888-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21-952175T00000X
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty