Most Relevant Information
Provider Data
| NPI Number: | 1003260233 |
| Provider Name: | BRIGHAM NICOLL |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/13/2016 |
| Last Updated: | 12/19/2019 |
Provider Practice Location
2601 E ROOSEVELT ST
PHOENIX
AZ
850084973
Practice Location Phone/Fax
| Phone: | 6023445011 |
| Fax: |
Provider Mailing Location
2601 E ROOSEVELT ST
PHOENIX
AZ
850084973
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |