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NPI Code Detail

MEDICARE: NICOLE KAY HURTADO PA-C

MEDICARE: NICOLE KAY HURTADO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant13753MN
2363A00000XPhysician Assistant5517WI

General Provider Information

NPI Number : 1619505047
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE KAY HURTADO PA-C
Provider Business Mailing Address
First Line : PO BOX 860912
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55486-0912
Country : US
Telephone Number : 507-284-2511
Fax Number :
Provider Business Practice Location Address
First Line : 1400 BELLINGER STREET
Second Line :
City : EAU CLAIRE
State : WI
Zip : 54703-5222
Country : US
Telephone Number : 715-838-5222
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2020
Last Update Date : 06/08/2026

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