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Contact Information

NICHOLAS SAMPLE, CAA
1836 SOUTH AVE
LA CROSSE, WI54601-5429
 Phone: 608-782-7300
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anesthesiologist Assistant

367H00000X 32 Anesthesiology Assistant
 

Athletic Trainer

2255A2300X
Indicates primary specialty

NPI Profile & details for NICHOLAS SAMPLE · (Male)

NPI # 1205236031
Status Active
Credentials CAA
Entity Individual
Enumeration date 08/29/2014
Last updated 10/29/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 195-17
Hospital affiliation(s)
  • GUNDERSEN LUTH MED CTR - (Acute Care)
    1910 SOUTH AVE
    LA CROSSE, WI 54601
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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