Provider Demographics
NPI:1891772000
Name:NICKELSEN, JAMES ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:NICKELSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:BLDG 2 STE 209
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-935-6252
Mailing Address - Fax:925-935-7611
Practice Address - Street 1:3010 COLBY ST
Practice Address - Street 2:STE 220
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2091
Practice Address - Country:US
Practice Address - Phone:510-644-2316
Practice Address - Fax:510-704-8346
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-12-22
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Provider Licenses
StateLicense IDTaxonomies
CAG51329207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G513290Medicare ID - Type Unspecified
CAA51971Medicare UPIN