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NPI Code Detail

MEDICARE: MS. NICOLE ANDERSON APRN, CNP

MEDICARE: MS. NICOLE ANDERSON APRN, CNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner8178MN

General Provider Information

NPI Number : 1902489339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE ANDERSON APRN, CNP
Provider Business Mailing Address
First Line : 1210 OAKEY CT
Second Line :
City : OSCEOLA
State : WI
Zip : 54020-4359
Country : US
Telephone Number : 651-206-2163
Fax Number :
Provider Business Practice Location Address
First Line : 1715 TOWER DR W STE 100
Second Line :
City : STILLWATER
State : MN
Zip : 55082-7609
Country : US
Telephone Number : 651-390-5001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2021
Last Update Date : 05/03/2021

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