NICKOLAS S JOHANNSEN , NPI 1598027666 — PHOENIX (AZ)

NPI 1598027666

7+ Years Experience Individual

NICKOLAS S JOHANNSEN

06/13/2012
PROVIDER ENUMERATION DATE
06/13/2012
LAST UPDATE DATE
1598027666
NPI NUMBER

About NICKOLAS S JOHANNSEN

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

NICKOLAS S JOHANNSEN is a provider established in PHOENIX, AZ. The NPI number of NICKOLAS S JOHANNSEN is 1598027666 and was assigned on 06/13/2012. The practitioners primary taxonomy code is: 247200000X .

Mailing address

  • City: PHOENIX
  • State: AZ
  • Postal code: 850322243
  • Phone: 6023547181
  • Address: 4015 E BELL RD
  • Address 2: STE 130

Primary Practice Address

  • Region : PHOENIX, AZ
  • NPI : 1598027666
  • Phone : 6023547181
  • Postalcode : 850322243
  • Address : 4015 E BELL RD STE 130

Provider taxonomy - Technician, Other

  • Taxonomy code: 247200000X

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.

Contacts:

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  • NICKOLAS S JOHANNSEN
  • Address : 4015 E BELL RD STE 130
  • Region : PHOENIX, AZ
  • NPI : 1598027666
  • Phone : 6023547181
  • Postalcode : 850322243

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4015 E BELL RD
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSTE 130
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NamePHOENIX
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameAZ
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code850322243
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number6023547181
The telephone number associated with the location address of the provider being identified.
NPI1598027666
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1247200000X
A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.
Provider Enumeration Date06/13/2012
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated06/13/2012
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)NICKOLAS S JOHANNSEN
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address4015 E BELL RD
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressSTE 130
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NamePHOENIX
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameAZ
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code850322243
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number6023547181
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #1247200000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Technician, Other
A collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specific technical processes and procedures; and where further classification is deemed unnecessary by the user.
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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