Provider Demographics
NPI:1932863974
Name:TATUMN, NICHOLS
Entity Type:Individual
Prefix:
First Name:NICHOLS
Middle Name:
Last Name:TATUMN
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 1:1526 ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3846
Mailing Address - Country:US
Mailing Address - Phone:920-917-1508
Mailing Address - Fax:
Practice Address - Street 1:1526 ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3846
Practice Address - Country:US
Practice Address - Phone:920-917-1508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator