Provider Demographics
NPI:1053617217
Name:NICHOLS, SCOTT (DVM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 5640
Mailing Address - Street 2:NORTHERN ARIZONA UNIVERSITY- BIOLOGICAL SCIENCES
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86011
Mailing Address - Country:US
Mailing Address - Phone:928-523-7318
Mailing Address - Fax:
Practice Address - Street 1:6122 ABINEAU CANYON DRIVE
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004
Practice Address - Country:US
Practice Address - Phone:928-523-7318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4754174MM1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174MM1900XOther Service ProvidersVeterinarianMedical Research