Healthcare Provider Details

I. General information

NPI: 1205581683
Provider Name (Legal Business Name): NIKKI PLYS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 02/15/2022
Certification Date: 02/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 CHAMBERSBURG AVE
DULUTH MN
55811-3004
US

IV. Provider business mailing address

1014 LINCOLN ST
SUPERIOR WI
54880-6716
US

V. Phone/Fax

Practice location:
  • Phone: 218-340-9766
  • Fax:
Mailing address:
  • Phone: 218-340-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number28612
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: