Nickolisen, Robert S
Nickolisen, Robert S is an sole proprietor health care provider with primary practice located at 601 W Riverside Dr Suites 3 And 4, Parker AZ 85344-5119. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Nickolisen, Robert S can be contacted via phone (602) 377-5900.Contact Information
Primary practice address
601 W Riverside Dr Suites 3 And 4
Parker AZ 85344-5119
Phone: (602) 377-5900
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 15301 | Arizona |
Profile Details
| NPI number | 1487692125 |
|---|---|
| LBN Legal business name | Nickolisen, Robert S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 3rd, 2006 |
| Last updated | Oct 27th, 2010 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1487692125 | NPPES |
| Arizona | MEDICAID | 250316 |
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