Provider Demographics
NPI:1811497001
Name:PRIMM, NICHOLAS RAYMOND
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RAYMOND
Last Name:PRIMM
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 1:86 JOE IVERSTINE PL
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2386
Mailing Address - Country:US
Mailing Address - Phone:985-237-2670
Mailing Address - Fax:
Practice Address - Street 1:86 JOE IVERSTINE PL
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2386
Practice Address - Country:US
Practice Address - Phone:985-237-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-14
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program