Provider Demographics
NPI:1952338790
Name:FRANK, NICHOL M (PA-C)
Entity Type:Individual
Prefix:
First Name:NICHOL
Middle Name:M
Last Name:FRANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICHOL
Other - Middle Name:M
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3916 N INTERTECH CT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913
Mailing Address - Country:US
Mailing Address - Phone:920-996-1000
Mailing Address - Fax:920-997-8302
Practice Address - Street 1:3916 N INTERTECH CT
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-996-1000
Practice Address - Fax:920-997-8302
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1471-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41974800Medicaid
WI41974800Medicaid
P90110Medicare UPIN