Provider Demographics
NPI:1932570728
Name:NICHOLSON, SONYA (CRNA)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:
Last Name:NICHOLSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12995 N ORACLE RD
Mailing Address - Street 2:STE 141, #411
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9528
Mailing Address - Country:US
Mailing Address - Phone:520-909-5673
Mailing Address - Fax:
Practice Address - Street 1:1267 S FLAXSEED DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4641
Practice Address - Country:US
Practice Address - Phone:520-909-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRNA1174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ197959Medicare PIN