DR. NICHOLAS WADE STULL (NPI# 1811384704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811384704 |
| Entity Type | Individual |
| Full Name | DR. NICHOLAS WADE STULL |
| Credential | D.O. |
| Practice Address |
3421 W 9th St Waterloo IA 50702-5401 |
| Practice Telephone | 3192728000 |
| Practice Fax Number | 3192727313 |
| Mailing Telephone | 2313131702 |
| Enumeration Date | 2015-04-19 |
| Last Update Date | 2019-07-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 5101021742 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | CONTROLLED SUBSTANCE LICENSE | 5315070508 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3421 W 9th St, Waterloo, IA 507025401 | 3192728000 | 3192727313 |
| 50 N Perry St, Pontiac, MI 483422217 | 2483385000 |
| Street Address |
3421 W 9TH ST |
| City | WATERLOO |
| State | IA |
| Zip Code | 50702-5401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740287614 | Nicholas J Goetsch | Family Medicine | 3421 W 9th St, Waterloo, IA 50702-5401 | 2005-07-06 |
| 1770101263 | Aaron Russell Haubrich | Podiatrist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2020-07-10 |
| 1629694682 | Nadia Nikoueiha | Podiatrist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2020-06-24 |
| 1386278117 | Kirre Hannan | Pharmacist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2020-03-02 |
| 1265094239 | Samuel Bernard | Podiatrist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2019-07-01 |
| 1306408125 | Trent Boyer | Podiatrist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2019-07-01 |
| 1467017921 | John Jacob Zion Kelly | Nurse Practitioner | 3421 W 9th St, Waterloo, IA 50702-5401 | 2019-05-09 |
| 1003381963 | Tyler James Goebel | Pharmacist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2018-10-08 |
| 1164907465 | Samantha Wheeler | Pharmacist | 3421 W 9th St, Waterloo, IA 50702-5401 | 2018-10-02 |
| 1063992857 | Kevin J Dirksen | Nurse Practitioner | 3421 W 9th St, Waterloo, IA 50702-5401 | 2018-08-21 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629684709 | Peoples Community Health Clinic, Inc | Clinic/Center | 425 1/2 East Ridgeway Ave., Waterloo, IA 50702 | 2020-09-23 |
| 1346867439 | Kinza Ali | Family Medicine | 2055 Kimball Avenue, Suite 101, Waterloo, IA 50702 | 2020-07-06 |
| 1073176533 | Sandeep Badyal | Family Medicine | Ne Ia Family Medicine Residency Program, 2055 Kimball Ave. Ste. 101, Waterloo, IA 50702 | 2019-04-19 |
| 1619530763 | Sophia Tariq Qureshi | Family Medicine | Ne Ia Medical Education Foundation, 2055 Kimball Ave. Ste. 101, Waterloo, IA 50702 | 2019-04-15 |
| 1659869915 | Alicia M Johnson | Advanced Practice Midwife | 439 King Street, Waterloo, IA 50702 | 2018-04-23 |
| 1427591411 | Alexandra E. Becker | Specialist/Technologist | 4157 Mourning Dove Drive, Waterloo, IA 50702 | 2016-11-23 |
| 1255793196 | Eastern Iowa Therapeutics PC | Physical Therapist | 1655 E San Marnan Dr, Ste A, Waterloo, IA 50702 | 2016-03-21 |
| 1972859288 | Noble Cedar Psychological Institute | Psychologist | 1425 W. 5th Street, Suite 1, Waterloo, IA 50702 | 2012-07-24 |
| 1417223363 | Rita Marie Menart | Counselor | 2101 Kimball Ave., Suite 138, Waterloo, IA 50702 | 2012-03-26 |
| 1336411685 | Jagpal Singh Suman | Hospitalist | 3421 West 9th Street, Waterloo, IA 50702 | 2012-02-02 |
| Find all providers in zip 50702 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164526349 | Robert Ansley Roof IIi | Emergency Medicine | 3421 West 9th St, Waterloo, IA 50702 | 2006-09-11 |
| 1881680130 | Jeffrey David Wilkins | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703-1916 | 2005-09-22 |
| 1699169698 | Jens Masters Olsen | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703 | 2015-03-27 |
| 1518387893 | Katie R Baker | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703-1916 | 2014-04-24 |
| 1396000337 | Orietta Girard | Emergency Medicine | 3840 W 9th St, Waterloo, IA 50702-5914 | 2012-07-05 |
| 1457611931 | William Paul Fangman | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703 | 2012-05-18 |
| 1447559893 | Stacey Marie Marlow Fisher | Emergency Medicine | 1825 Logan Ave, Emergency Department, Allen Memorial Hospital, Waterloo, IA 50703-1916 | 2011-03-24 |
| 1386879427 | Iowa Emergency Physicians LLP | Emergency Medicine | 3421 West Ninth Street, Waterloo, IA 50702-5401 | 2009-05-19 |
| 1043479355 | Brian K Sankey | Emergency Medicine | 2710 Saint Francis Dr, Suite 210, Waterloo, IA 50702-5619 | 2008-06-03 |
| 1891953543 | Joseph Kwofie | Emergency Medicine | 1825 Logan Ave, Waterloo, IA 50703 | 2008-05-29 |
| Find all providers in WATERLOO | ||||
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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.