Provider Demographics
NPI:1154869576
Name:NICOLAYSEN, ANTHONY PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PAUL
Last Name:NICOLAYSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11550 INDIAN HILLS RD STE 371
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1252
Mailing Address - Country:US
Mailing Address - Phone:818-365-1194
Mailing Address - Fax:818-898-3635
Practice Address - Street 1:11550 INDIAN HILLS RD STE 371
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1252
Practice Address - Country:US
Practice Address - Phone:818-365-1194
Practice Address - Fax:818-898-3835
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA174994207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology