Provider Demographics
NPI:1780839605
Name:NICHOLS, DANIEL JAMES (MS, MSM, PA-C)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JAMES
Last Name:NICHOLS
Suffix:
Gender:
Credentials:MS, MSM, PA-C
Other - Prefix:MR
Other - First Name:DAN
Other - Middle Name:
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MSM, PA-C
Mailing Address - Street 1:202 10TH ST SE STE 140
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2432
Mailing Address - Country:US
Mailing Address - Phone:319-398-1545
Mailing Address - Fax:309-762-3690
Practice Address - Street 1:202 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-247-3010
Practice Address - Fax:877-303-8768
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000008652255A2300X
IL085005376363A00000X
TN2401363AM0700X
IA074769363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical