Andra L Nicholson Sr.

Primary specialty

DriverTaxonomy code 172A00000X

License

N242-0126-3466-07 Issued in WI

Practice address

1724 W Clarke St
Milwaukee, WI 53206-2030

Phone

(414) 763-9892

Fax

(414) 763-0531

NPI assigned

Oct 28, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1635379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1093479701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1724 W CLARKE ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532062030",
            "telephone_number": "414-763-9892",
            "fax_number": "414-763-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1724 W CLARKE ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532062030",
            "telephone_number": "414-763-9892",
            "fax_number": "414-763-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLSON",
        "first_name": "ANDRA",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-28",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172A00000X",
            "taxonomy_group": "",
            "desc": "Driver",
            "state": "WI",
            "license": "N242-0126-3466-07",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany A Nichols
• Colleen Mary Nichols, M.D.
• Kathleen L Nichols, CNA
• Kyle B Nichols, MD
• Matthew David Nichols, DO
• Kristen Nicholson, LPC
• Rebecca Kamperschroer Nickels, PA
• Sarah Jane Nickoloff, M.D.
• Nicole V Zellner, LLC
• Margaret Maryellen Nicoud, NURSE PRACTITIONER

• Driver in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Driver in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.