Provider Demographics
NPI:1972860476
Name:NICHOLSON, NATHAN ALLAN
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALLAN
Last Name:NICHOLSON
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 1:1001 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-6427
Mailing Address - Country:US
Mailing Address - Phone:641-684-3196
Mailing Address - Fax:641-684-3199
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6427
Practice Address - Country:US
Practice Address - Phone:641-684-3196
Practice Address - Fax:641-684-3199
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery