Basic Information
| Provider Information | |||||||||
| NPI: | 1346995693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VADEN | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | FNP-C, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8746 MERRIMAC | ||||||||
| Address2: | |||||||||
| City: | RICHLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490839331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693035079 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 117 W PATERSON ST | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490072581 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693492641 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2022 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704329636 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.