Basic Information
| Provider Information | |||||||||
| NPI: | 1063587947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLLS | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 EAST 28TH STREET | ||||||||
| Address2: | MR 11112 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128636590 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1925 WOODWINDS DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512320228 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2006 | ||||||||
| LastUpdateDate: | 09/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | EC-05-141 | ME | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 49580 | MN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.