Basic Information
| Provider Information | |||||||||
| NPI: | 1760898795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NICHOLSON | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7147 VISTA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | WEST DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 502669313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759925 | ||||||||
| FaxNumber: | 5158759923 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 ADVENTURELAND DR NW STE C | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 50009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5158759020 | ||||||||
| FaxNumber: | 5158759021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2014 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-10127 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | DO-04817 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.