Provider Demographics
NPI:1548366347
Name:NICHOLS, ALVIN KIRK (CRNA)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:KIRK
Last Name:NICHOLS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1954 FORT UNION BLVD
Mailing Address - Street 2:STE 114
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6899
Mailing Address - Country:US
Mailing Address - Phone:800-594-5736
Mailing Address - Fax:
Practice Address - Street 1:1954 FORT UNION BLVD
Practice Address - Street 2:STE 114
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6899
Practice Address - Country:US
Practice Address - Phone:800-594-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3319524406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT16311OtherHEALTHY U
UT33195244000001OtherBCBS
UT68308OtherPEHP
UT190683600OtherUS DEPT OF LABOR
UT740685OtherDESERET MUTUAL
UTPRA07054OtherMOLINA
UT870666269NICOtherEDUCATORS MUTUAL
UT107011533101OtherIHC
UTQM0000054865OtherALTIUS