Stephen Nicholls, M.D.

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

MD00023966 Issued in WA

Practice address

200 NE Mother Joseph PL
Suite 330
Vancouver, WA 98664-3299

Phone

(360) 514-1854

Fax

(360) 514-6063

NPI assigned

Jun 29, 2006

Last updated

Sep 30, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: snicholls115253@wellspan.direct-ci.com

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475193600000",
    "number": "1437187598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 BROADWAY 112",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981225381",
            "telephone_number": "206-420-3119",
            "fax_number": "206-453-5912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL",
            "address_2": "SUITE 330",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643299",
            "telephone_number": "360-514-1854",
            "fax_number": "360-514-6063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLLS",
        "first_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2016-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "23966",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "WA",
            "license": "MD00023966",
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "PA",
            "license": "MD03825IL",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8105322",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vinh Xuan Nguyen, PHARMD
• Jaime A Nicacio, MD
• Nicholas F. Carulli MD, PC (Carulli Medical Clinic)
• Nicholas Raklios, DDS, PLLC (Must Love Kids Pediatric Dentistry)
• Shannon La Rae Nicholles
• Cassandra Marie Nichols
• Kristeen Marie Nichols, RDH
• Laura T Nichols, BA
• Lisa Nichols, LMT
• Lynn Marie Nichols, PTA

• Vascular Surgery Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Vascular Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2016; 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.