Wickersham, Nicholas Wendell

Wickersham, Nicholas Wendell is an sole proprietor health care provider with primary practice located at 1100 Balsam Ave , Boulder CO 80304-3404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wickersham, Nicholas Wendell can be contacted via phone (303) 532-3500.

Contact Information

Primary practice address
1100 Balsam Ave Boulder CO 80304-3404
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 47842 Colorado

Profile Details

NPI number 1396867222
LBN Legal business name Wickersham, Nicholas Wendell
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 3rd, 2007
Last updated Mar 15th, 2021 - about 3 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396867222 NPPES
Colorado MEDICAID 07101759

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