Nicholas Pedersen

Physician Assistant · Cumberland, WI

Individual Active NPI

NPI number 1619502275

Practice location

1705 16TH Ave
Cumberland, WI 54829-8601
Phone
(715) 822-7500
Fax
(715) 822-7501

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NPI record

NPI
1619502275
Entity type
Individual (Type 1)
Enumeration date
March 4, 2020
Last updated
March 24, 2026
Certified
March 24, 2026
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X 5071 WI

About Nicholas Pedersen

Nicholas Pedersen is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 1705 16TH Ave, Cumberland, WI 54829-8601. The NPI number 1619502275 was assigned on March 4, 2020 and the record was last updated on March 24, 2026.

Nicholas Pedersen lists a license in the registry: #5071 (WI) for Physician Assistant. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Nicholas Pedersen?

The NPI number is 1619502275.

What is the phone number of Nicholas Pedersen?

The phone number listed for the practice location is (715) 822-7500.

Where is Nicholas Pedersen located?

1705 16TH Ave, Cumberland, WI 54829-8601.

What is the taxonomy code for Nicholas Pedersen?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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