Provider Demographics
NPI:1932857695
Name:NIKANI, XOLISA BUHLE
Entity Type:Individual
Prefix:
First Name:XOLISA
Middle Name:BUHLE
Last Name:NIKANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2205
Mailing Address - Country:US
Mailing Address - Phone:515-528-1027
Mailing Address - Fax:515-646-5310
Practice Address - Street 1:1511 E 9TH ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2205
Practice Address - Country:US
Practice Address - Phone:515-528-1027
Practice Address - Fax:515-646-5310
Is Sole Proprietor?:No
Enumeration Date:2022-03-12
Last Update Date:2022-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA180035172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker