Provider Demographics
NPI:1720430853
Name:CROMIDAS, NICHOLAS
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:CROMIDAS
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 1:1920 NE TERRE VIEW DR
Mailing Address - Street 2:APT. I203
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-4591
Mailing Address - Country:US
Mailing Address - Phone:661-713-0996
Mailing Address - Fax:
Practice Address - Street 1:1920 NE TERRE VIEW DR
Practice Address - Street 2:APT. I203
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-4591
Practice Address - Country:US
Practice Address - Phone:661-713-0996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer