Provider Demographics
NPI:1871282483
Name:POPP, NICHOLAS RONALD (BS)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RONALD
Last Name:POPP
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4641 S HEARTH RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-9250
Mailing Address - Country:US
Mailing Address - Phone:262-825-6230
Mailing Address - Fax:
Practice Address - Street 1:4641 S HEARTH RIDGE CT
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-9250
Practice Address - Country:US
Practice Address - Phone:262-825-6230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program