Basic Information
| Provider Information | |||||||||
| NPI: | 1477126662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICOLAS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GATCHALIAN | ||||||||
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| Credential: | MSN, APRN, FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2545 S BRUCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891691778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375043 | ||||||||
| Practice Location | |||||||||
| Address1: | 2545 S BRUCE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891691778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027322438 | ||||||||
| FaxNumber: | 7027375043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 844813 | NV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 844813 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.