Robert S Nickolisen, MD

Primary specialty

SpecialistTaxonomy code 174400000X

License

15301 Issued in AZ

Practice address

601 W Riverside Dr
Suites 3 and 4
Parker, AZ 85344-5119

Phone

(602) 377-5900

NPI assigned

Jun 3, 2006

Last updated

Oct 27, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Western Urological Associates, PC

  • Specialist
  • Parker, AZ
  • NPI 1699957332
  NPD Authorized official
• Privia Medical Group Arizona, LLC

  • Neurology Physician
  • Phoenix, AZ
  • NPI 1245876705
  NPD (past)
• Privia Medical Group Arizona, LLC

  • Family Medicine Physician
  • Phoenix, AZ
  • NPI 1760441141
  NPD (past)

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1487692125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2485 STROKE DR",
            "city": "LAKE HAVASU CITY",
            "state": "AZ",
            "postal_code": "864067622",
            "telephone_number": "602-377-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 W RIVERSIDE DR",
            "address_2": "SUITES 3 AND 4",
            "city": "PARKER",
            "state": "AZ",
            "postal_code": "853445119",
            "telephone_number": "602-377-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICKOLISEN",
        "first_name": "ROBERT",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "15301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250316",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leah Morris
• Jaime Muniz
• Khalid Naqi, MD
• Nazcare, Inc - Pride Wellness Center
• Kathleen Nelson
• Linda M Nocilla, CLS
• Julia Ann Nofrada, RN
• Raquel Nopah, NURSE'S AIDE
• Laurence Martin Novick, MD
• Jesdeen Lynn Nunez

• Specialist in Parker, AZ
• Providers in Parker, AZ by specialty
• Specialist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.