Provider Demographics
NPI:1447488630
Name:NICHOLSON-UHL, CRAIG JASON (NP)
Entity type:Individual
Prefix:
First Name:CRAIG JASON
Middle Name:
Last Name:NICHOLSON-UHL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3122
Mailing Address - Country:US
Mailing Address - Phone:504-349-6352
Mailing Address - Fax:504-349-6356
Practice Address - Street 1:4500 10TH ST
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-3122
Practice Address - Country:US
Practice Address - Phone:504-349-6352
Practice Address - Fax:504-349-6356
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP05817OtherLICENSE
LA1885215Medicaid
LAAP05817OtherLICENSE