Provider Demographics
NPI:1295137719
Name:FRANCIS, NICHOLAS DALE (PA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DALE
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31829 3RD PL SW
Mailing Address - Street 2:13D
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-4839
Mailing Address - Country:US
Mailing Address - Phone:314-489-5266
Mailing Address - Fax:
Practice Address - Street 1:31829 3RD PL SW
Practice Address - Street 2:13D
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-4839
Practice Address - Country:US
Practice Address - Phone:314-489-5266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATA60510839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant