DR. BRENT G NICHOLS (NPI# 1275858714) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275858714 |
| Entity Type | Individual |
| Full Name | DR. BRENT G NICHOLS |
| Credential | MD |
| Practice Address |
801 Broadway N Fargo ND 58102-3641 |
| Mailing Address |
339 Teeters Ct Iowa City IA 52246-3839 |
| Practice Telephone | 7012342000 |
| Mailing Telephone | (641) 750-0190 |
| Enumeration Date | 2010-03-27 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | 13649 | ND | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 9200 W Wisconsin Ave, Milwaukee, WI 532263522 | 4148055609 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548485584 | Brent Owen Nichols | Dentist | 305 Orange Ave Ste A, Huntington Beach, CA 92648-8128 | 2007-04-16 |
| 1508072562 | Brent Nichols | Social Worker | 26 W 9th St, #1g, New York, NY 10011-8971 | 2007-05-15 |
| 1861610594 | Brent H Nichols | Counselor | 1421 Lee St, Brunswick, GA 31520-7132 | 2007-04-20 |
| Street Address |
801 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-3641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528062924 | Mark F Fisher | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2005-06-13 |
| 1942809652 | Morgan Margaret Borud | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-10-22 |
| 1790392462 | Katie Thielges | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-09-28 |
| 1063022432 | Lindsey Schmidt | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-07-31 |
| 1336766161 | Yesha Shukla | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-27 |
| 1891310850 | Samantha Mimi Chang | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-15 |
| 1528683224 | Briana Lee Gebert-oberle | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-09 |
| 1689296931 | Jillian Virginia Schommer | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-05-09 |
| 1194344036 | Sarah Rose Carpenter | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-04-10 |
| 1346871258 | Randall Hagemeister | Nurse Anesthetist, Certified Registered | 801 Broadway N, Fargo, ND 58102-3641 | 2020-01-29 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700944915 | Lesley A Soine | Otolaryngology | 2700 12th Ave S, Ste D, Fargo, ND 58103-8723 | 2006-12-04 |
| 1992803662 | Sue Karen Wink | Otolaryngology | 1800 21st Ave S, Fargo, ND 58103-5759 | 2006-09-20 |
| 1982606000 | Ferdinand Lavenuta | Otolaryngology | 1214 Oak St N, Fargo, ND 58102-2707 | 2005-06-01 |
| 1245585587 | Morgan Lien | Otolaryngology | 801 Broadway N, Fargo, ND 58102-3641 | 2012-07-23 |
| 1720285323 | Andrew Michael Terrell | Otolaryngology | 801 Broadway N, Fargo, ND 58102-3641 | 2007-06-28 |
| 1942416714 | Matthew Walter Miller | Otolaryngology | 801 Broadway N, Fargo, ND 58122 | 2007-05-16 |
| 1447395512 | Michael J Shinners | Otolaryngology | 801 Broadway N, Fargo, ND 58102-3641 | 2007-02-20 |
| 1952469165 | Susan M Mathison | Otolaryngology | 1800 21st Ave S, Fargo, ND 58103 | 2006-12-04 |
| 1043378268 | Catalyst Medical Center PC | Otolaryngology | 1800 21st Ave S, Fargo, ND 58103 | 2006-12-04 |
| 1649338724 | James L. Frisk, M.d., Ltd | Otolaryngology | 2700 12th Ave S, Suite D, Fargo, ND 58103-8723 | 2006-12-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.